乳酸清除率对感染性创面导致脓毒性休克患者疗效与生存状况的评估价值

发布时间：2018-08-26 14:22

【摘要】：目的探讨乳酸清除率对感染性创面导致脓毒性休克患者疗效与生存状况的评估价值。方法选取2015年1月-2016年1月在医院住院治疗的感染性创面导致脓毒性休克患者64例,在治疗30d后,根据患者是否发生多器官功能障碍综合征(MODS)将患者分为MODS组和非MODS组,并根据患者的生存状况分为死亡组和存活组,比较两组患者的乳酸水平以及乳酸清除率;并根据所有患者的乳酸清除率的高低将患者分为高乳酸清除率组和低乳酸清除率组,比较两组患者MODS和死亡发生率,确定乳酸清除率与感染性创面导致脓毒性休克患者MODS发生率、生存率的相关性,并对感染病原菌进行鉴定和分析。结果存活组22例,死亡组42例,存活组复苏24h后乳酸水平显著低于死亡组,存活组乳酸清除率显著高于死亡组,差异均有统计学意义;MODS组27例,非MODS组37例,非MODS组复苏24h后乳酸水平显著低于MODS组,非MODS组乳酸清除率显著高于MODS组,差异均有统计学意义;高乳酸清除率组的病死率和MODS发生率均显著低于低乳酸清除率组,差异有统计学意义;复苏24h后乳酸水平与MODS发生率和病死率具有显著正相关,乳酸清除率与MODS发生率和病死率具有显著负相关;感染患者60例共分离培养出81株病原菌,以革兰阴性菌为主47株占58.0%,主要包括铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌,革兰阳性菌32株占39.5%,主要包括溶血葡萄球菌、金黄色葡萄球菌、粪肠球菌,真菌2株占2.5%。结论乳酸清除率可以帮助评估感染性创面导致的脓毒性休克患者的疗效和生存状况;对于乳酸清除率较低的患者一定要及时给予合理的干预措施,在治疗感染的过程中要合理使用抗菌药物,有效提升感染性创面导致的脓毒性休克患者的预后。
[Abstract]:Objective to evaluate the efficacy and survival of lactate clearance rate in septic shock patients. Methods from January 2015 to January 2016, 64 patients with septic shock caused by septic wound were selected. After 30 days of treatment, patients were divided into MODS group and non-MODS group according to whether the patients had multiple organ dysfunction syndrome (MODS). According to the survival status of the patients, they were divided into death group and survival group, the lactate level and lactate clearance rate of the two groups were compared, and the patients were divided into high lactate clearance group and low lactate clearance group according to the level of lactate clearance rate of all patients. The correlation between lactate clearance rate and MODS incidence and survival rate in septic shock patients caused by septic wound was determined by comparing the MODS and death rates of the two groups. The pathogenic bacteria were identified and analyzed. Results the lactate level in the survival group was significantly lower than that in the death group after 24 hours of resuscitation, and the lactate clearance rate in the survival group was significantly higher than that in the dead group. The difference was statistically significant in 27 cases in mods group and 37 cases in non-mods group. The lactic acid level in the non MODS group was significantly lower than that in the MODS group after 24 h resuscitation, and the lactate clearance rate in the non MODS group was significantly higher than that in the MODS group, the difference was statistically significant, the mortality and MODS incidence in the high lactate clearance group were significantly lower than those in the low lactate clearance group. After 24 hours of resuscitation, the lactic acid level was positively correlated with the incidence and mortality of MODS, and the clearance rate of lactic acid was negatively correlated with the incidence and mortality of MODS. 47 strains of Gram-negative bacteria accounted for 58.0%, including Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and 32 Gram-positive bacteria, including haemolytic Staphylococcus, Staphylococcus aureus, Enterococcus faecalis. Two strains of fungi accounted for 2.5%. Conclusion the clearance rate of lactic acid can help to evaluate the curative effect and survival status of septic shock patients caused by infectious wound, the patients with low clearance rate of lactic acid must be given reasonable intervention measures in time. In order to improve the prognosis of septic shock patients caused by infectious wounds, the rational use of antimicrobial agents should be used in the treatment of infection.
【作者单位】：绍兴市人民医院浙江大学绍兴医院重症医学科;
【基金】：浙江省医药卫生科技计划基金资助项目(2015ZDA030)
【分类号】：R459.7

【相似文献】