动脉血乳酸及乳酸清除率对颅脑外伤患者的预后评估价值

发布时间：2018-10-08 19:34

【摘要】：目的急性颅脑外伤后,患者动脉血乳酸及乳酸清除率在一定程度上反应了病情严重程度。文中旨在探讨动脉血乳酸及乳酸清除率在评估颅脑外伤患者预后的价值。方法回顾性分析南京军区南京总医院急诊科2015年2月至2015年11月收治的颅脑外伤患者94例基本资料。在患者入院时立即进行GCS评分,动脉血乳酸、血压、心率的测定,在入院6 h后再次测定动脉血乳酸浓度,计算其动脉血乳酸清除率。将所有患者分别按格拉斯哥昏迷评分分值分为轻度组(13~15分)、中度组(9~12分)和重度组(3~8分),并根据预后分为死亡组和存活组,分别比较各组的动脉血乳酸值及乳酸清除率。结果轻、中、重度3组动脉血乳酸浓度间差异有统计学意义(F=19.99,P0.01),且6 h乳酸清除率组间差异亦有统计学意义(F=6.21,P0.01)。死亡组的初始血乳酸浓度明显高于存活组[(4.20±1.36)mmol/L vs(1.58±0.93)mmol/L],差异有统计学意义(t=-9.78,P0.01);死亡组的6 h乳酸清除率明显低于存活组[(31.73±12.84)%vs(46.25±12.01)%],差异有统计学意义(t=4.55,P0.01)。结论在颅脑外伤的患者中,动脉血乳酸及6 h乳酸清除率可较好地评估患者的病情程度及预后,在临床中具有重要应用价值。
[Abstract]:Objective to reflect the severity of acute craniocerebral injury in patients with acute craniocerebral injury. The purpose of this study was to evaluate the value of arterial lactate and lactate clearance rate in evaluating the prognosis of patients with craniocerebral trauma. Methods the data of 94 patients with craniocerebral trauma admitted from February 2015 to November 2015 in the emergency department of Nanjing General Hospital of Nanjing military region were retrospectively analyzed. GCS score, arterial blood lactic acid, blood pressure and heart rate were measured immediately after admission. Arterial blood lactate concentration was measured again 6 hours after admission, and the clearance rate of arterial blood lactic acid was calculated. According to Glasgow coma score, all patients were divided into mild group (1315 points), moderate group (9-12 points) and severe group (3-8 points). According to the prognosis, they were divided into death group and survival group. Results there were significant differences in arterial lactate concentration among the mild, moderate and severe groups (F _ (19. 9) P _ (0.01), and there was also a significant difference in the clearance rate of lactate at 6 hours (F _ (6.21) P _ (0.01). The initial lactate concentration in the death group was significantly higher than that in the survival group [(4.20 卤1.36) mmol/L vs (1.58 卤0.93) mmol/L], the difference was statistically significant (t = 9.78, P 0.01), and the 6-hour lactate clearance rate in the death group was significantly lower than that in the surviving group [(31.73 卤12.84) vs (46.25 卤12.01)%] (t 4.55, P 0.01). Conclusion in patients with craniocerebral trauma, the removal rate of arterial lactic acid and 6-hour lactate can evaluate the degree of illness and prognosis of the patients, and it is of great value in clinical application.
【作者单位】：南方医科大学金陵医院(南京军区南京总医院)急救医学科;
【基金】：国家自然科学基金(81401583) 中国急诊医师协会专项科研基金(R2014004) 全军后勤面上项目(CNJ14L002)
【分类号】：R651.15

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