血乳酸及乳酸清除率在无创通气治疗AECOPD合并Ⅱ型呼衰中的临床价值
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摘要
目的探讨血乳酸及乳酸清除率在无创通气治疗AECOPD合并Ⅱ型呼衰中的指导意义。方法收集2017年1—12月江门市中心医院呼吸科收治的符合AECOPD合并Ⅱ型呼衰并使用无创通气治疗的患者78例为研究对象。按患者病情转归分为存活组62例以及死亡组16例。记录患者的PCT、BNP、血乳酸及乳酸清除率,同时比较两组患者的血乳酸、乳酸清除率、PCT、BNP。并采用Pearson相关分析分析PCT及BNP与LAC的相关性。结果死亡组入院时及入院后2 h、6 h、24 h的血乳酸水平(7.31±2.28,6.58±2.45,6.14±2.37,6.35±2.28 mmol/L)均高于生存组(3.88±1.47,2.77±1.24,2.27±1.04,1.84±0.91)mmol/L,2 h、6 h、24 h的乳酸清除率(0.092±0.195,0.155±0.195,0.114±0.254)%均低于生存组(0.278±0.15,0.408±0.145,0.524±0.114)%,差异有统计学意义(P<0.05)。入院时血乳酸水平与PCT及BNP水平呈正相关。结论血乳酸及乳酸清除率在无创通气治疗AECOPD合并Ⅱ型呼衰中有很好的指导价值。
Objective To investigate the clinical value of blood lactate and lactate clearance rate to noninvasive ventilation in the treatment of AECOPD with type Ⅱ respiratory failure. Methods 78 patients of AECOPD with type Ⅱ respiratory failure and treated with non-invasive ventilation in Respiratory Department of Jiangmen Central Hospital from January 2017 to December 2017 were collected. The patients were divided into survival group and death group according to the final outcome. PCT,BNP,LAC and LCR were recorded and compared between two groups. Pearson correlation analysis was used to analyze the correlation between PCT and BNP and LAC. Results The blood lactate level when admitted and after 2 hr,6 hr,24 hr in death group( 7.31±2.28,6.58±2.45,6.14±2.37,6.35±2.28 mmol/L) were higher than the survival group( 3.88±1.47,2.77±1.24,2.27±1.04,1.84±0.91) mmol/L. The death group had a lower 2 hr,6 hr,24 hr LCR( 0.092±0.195,0.155±0.195,0.114±0.254) % than the survival group( 0. 278 ± 0. 15,0. 408 ± 0. 145,0. 524 ± 0. 114) %. The value showed a linear positive correlation between LAC and PCT and BNP,P<0.05,considered statistically significant. Conclusions Blood lactate and lactate clearance rate have effective guiding significance to non-invasive ventilation in the treatment of AECOPD with type Ⅱ respiratory failure.
Objective To investigate the clinical value of blood lactate and lactate clearance rate to noninvasive ventilation in the treatment of AECOPD with type Ⅱ respiratory failure. Methods 78 patients of AECOPD with type Ⅱ respiratory failure and treated with non-invasive ventilation in Respiratory Department of Jiangmen Central Hospital from January 2017 to December 2017 were collected. The patients were divided into survival group and death group according to the final outcome. PCT,BNP,LAC and LCR were recorded and compared between two groups. Pearson correlation analysis was used to analyze the correlation between PCT and BNP and LAC. Results The blood lactate level when admitted and after 2 hr,6 hr,24 hr in death group( 7.31±2.28,6.58±2.45,6.14±2.37,6.35±2.28 mmol/L) were higher than the survival group( 3.88±1.47,2.77±1.24,2.27±1.04,1.84±0.91) mmol/L. The death group had a lower 2 hr,6 hr,24 hr LCR( 0.092±0.195,0.155±0.195,0.114±0.254) % than the survival group( 0. 278 ± 0. 15,0. 408 ± 0. 145,0. 524 ± 0. 114) %. The value showed a linear positive correlation between LAC and PCT and BNP,P<0.05,considered statistically significant. Conclusions Blood lactate and lactate clearance rate have effective guiding significance to non-invasive ventilation in the treatment of AECOPD with type Ⅱ respiratory failure.
引文
[1]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].全科医学临床与教育,2013,36(5):255-264.
[2]秦娥.慢性阻塞性肺疾病急性加重期患者血清降钙素原测定的临床意义[J].现代实用医学,2010,22(6):676-677.
[3]慢性阻塞性肺疾病急性加重诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志,2014,34(1):1-11.
[4]黄庆,朱建军.影响COPD急性加重期患者无创通气治疗有效性的因素[J].江苏医药,2015,41(1):27-30.
[5]秦志强,谢灿茂.常见呼吸系统疾病气管插管机械通气指征[J].新医学,2011,42(7):421-425.
[6]蒋文中,汤彦.危重病乳酸增高机制及其在预后中价值[J].临床荟萃,2004,19(7):405-407.
[7]Jansen TC,Van BJ,Bakker J.Blood lactate monitoring in critically ill patients:a systematic health technology assessment[J].Critical Care Medicine,2010,37(10):2827-2839.
[8]Mcnelis J,Marini CP,Jurkiewicz A,et al.Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit.[J].American Journal of Surgery,2001,182(5):481-485.
[9]Donnino MW,Miller J,Goyal N,et al.Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients[J].Resuscitation,2007,75(2):229-34.
[10]赵云峰,林勇,朱晓莉,等.早期乳酸清除率对呼吸衰竭患者预后判定的意义[J].中华结核和呼吸杂志,2010,33(3):20.
[11]Suárez-Santamaría M,Santolaria F,Pérez-Ramírez A,et al.Prognostic value of inflammatory markers(notably cytokines and procalcitonin),nutritional assessment,and organ function in patients with sepsis[J].European Cytokine Network,2010,21(1):19.
[12]Dombrovskiy VY,Martin AA,Sunderram J,et al.Rapid increase in hospitalization and mortality rates for severe sepsis in the United States:a trend analysis from 1993 to 2003[J].Critical Care Medicine,2007,35(5):1244.
[13]吴晓艳,刘军,沈清,等.降钙素原与乳酸水平的监测在糖尿病酮症酸中毒合并感染中的相关分析[J].临床急诊杂志,2017(3):225-228.
[14]Pascual-Figal DA,Antolinos MJ,Bayes‐Genis A,et al.B-type natriuretic peptide release in the coronary effluent after acute transient ischaemia in humans[J].Digest of the World Core Medical Journals,2007,93(9):1077-1080.
[2]秦娥.慢性阻塞性肺疾病急性加重期患者血清降钙素原测定的临床意义[J].现代实用医学,2010,22(6):676-677.
[3]慢性阻塞性肺疾病急性加重诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志,2014,34(1):1-11.
[4]黄庆,朱建军.影响COPD急性加重期患者无创通气治疗有效性的因素[J].江苏医药,2015,41(1):27-30.
[5]秦志强,谢灿茂.常见呼吸系统疾病气管插管机械通气指征[J].新医学,2011,42(7):421-425.
[6]蒋文中,汤彦.危重病乳酸增高机制及其在预后中价值[J].临床荟萃,2004,19(7):405-407.
[7]Jansen TC,Van BJ,Bakker J.Blood lactate monitoring in critically ill patients:a systematic health technology assessment[J].Critical Care Medicine,2010,37(10):2827-2839.
[8]Mcnelis J,Marini CP,Jurkiewicz A,et al.Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit.[J].American Journal of Surgery,2001,182(5):481-485.
[9]Donnino MW,Miller J,Goyal N,et al.Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients[J].Resuscitation,2007,75(2):229-34.
[10]赵云峰,林勇,朱晓莉,等.早期乳酸清除率对呼吸衰竭患者预后判定的意义[J].中华结核和呼吸杂志,2010,33(3):20.
[11]Suárez-Santamaría M,Santolaria F,Pérez-Ramírez A,et al.Prognostic value of inflammatory markers(notably cytokines and procalcitonin),nutritional assessment,and organ function in patients with sepsis[J].European Cytokine Network,2010,21(1):19.
[12]Dombrovskiy VY,Martin AA,Sunderram J,et al.Rapid increase in hospitalization and mortality rates for severe sepsis in the United States:a trend analysis from 1993 to 2003[J].Critical Care Medicine,2007,35(5):1244.
[13]吴晓艳,刘军,沈清,等.降钙素原与乳酸水平的监测在糖尿病酮症酸中毒合并感染中的相关分析[J].临床急诊杂志,2017(3):225-228.
[14]Pascual-Figal DA,Antolinos MJ,Bayes‐Genis A,et al.B-type natriuretic peptide release in the coronary effluent after acute transient ischaemia in humans[J].Digest of the World Core Medical Journals,2007,93(9):1077-1080.