重症肺炎患者动脉血乳酸及中心静脉血氧饱和度监测的意义
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摘要
目的研究重症肺炎患者,监测动脉血乳酸(Lac)、中心静脉血氧饱和度(ScvO_2)的意义。方法本院47例重症肺炎患者(2015年1月至2018年3月),测定入院各时刻(0 h、6 h、24 h、72 h)动脉血Lac及ScvO_2,完成相关检验,进行入院前3 d急性生理与慢性健康(APACHE慢)评分,根据患者入院第28天预后,分为生存组及死亡组,记录两组各时段动脉血乳酸及ScvO_2,比较其差别及相关性。结果死亡组入院6 h、24 h、72 h动脉血Lac高于存活组,ScvO_2低于存活组,差异有统计学意义(P<0.05)。死亡组入院APACHE学评分更高,且6 h乳酸清除率较低。结论重症肺炎患者预后与动脉血Lac的6 h清除率及ScvO_2密切相关。
Objective To investigate the significance of monitoring arterial blood lactic acid(Lac) and central venous oxygen saturation(ScvO_2)in patients with severe pneumonia. Methods From January 2015 to March 2018, 47 patients with severe pneumonia in our hospital were determined at times of admission hospital(0 h, 6 h, 24 h, 72 h) of arterial blood Lac and ScvO_2, and related tests were completed. Acute physiology and chronic health(APACHE II) scores were performed 3 days before admission. According to the prognosis of the 28 th day of the patient's admission, it was divided into survival group and death group. The difference and correlation between the two groups of arterial blood lactic acid and ScvO_2 were recorded. Results The death group was admitted to hospital with 6 h, 24 h, and 72 h arterial blood Lac higher than the survival group, and Scv02 was lower than the survival group(P<0.05), and the difference was statistically significant. The death group was admitted to the APACHE II with a higher score and a lower removal rate of 6 h lactic acid. Conclusion The prognosis of patients with severe pneumonia is closely related to the rate of Lac 6 h clearance of arterial blood and ScvO_2.
Objective To investigate the significance of monitoring arterial blood lactic acid(Lac) and central venous oxygen saturation(ScvO_2)in patients with severe pneumonia. Methods From January 2015 to March 2018, 47 patients with severe pneumonia in our hospital were determined at times of admission hospital(0 h, 6 h, 24 h, 72 h) of arterial blood Lac and ScvO_2, and related tests were completed. Acute physiology and chronic health(APACHE II) scores were performed 3 days before admission. According to the prognosis of the 28 th day of the patient's admission, it was divided into survival group and death group. The difference and correlation between the two groups of arterial blood lactic acid and ScvO_2 were recorded. Results The death group was admitted to hospital with 6 h, 24 h, and 72 h arterial blood Lac higher than the survival group, and Scv02 was lower than the survival group(P<0.05), and the difference was statistically significant. The death group was admitted to the APACHE II with a higher score and a lower removal rate of 6 h lactic acid. Conclusion The prognosis of patients with severe pneumonia is closely related to the rate of Lac 6 h clearance of arterial blood and ScvO_2.
引文
[1]中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,2006,29(10):651-655.
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[2]American Thoracic Society.Guidelines for the management of adults with community acquired pneumonia[J].Am J Crit Care Med,2001,163(7):1730-1754.
[3]管向东,寇秋野.感染性休克血流动力学的监测指标[J].创伤外科杂志,2007,9(2):97-99.
[4]American Thoracic Society,Infectious Diseases Society of America.Guideline of the management of adults with hospital‐acquired,ventilator‐associated,and healthcare associated pneumonia[J].Am JRespire Crit Care Med,2005,171(4):388-416.
[5]Nguyen HB,Rivers EP,Knoblich BP,et a1.Early lactate clearance is associated with improved outcome in severe sepsis and septic shock[J].Crit Care Med,2004,32(8):1637-1642.
[6]高伟波,曹宝平,陈子涛,等.乳酸和乳酸清除率对危重症患者的意义[J].中华急诊医学杂志2012,12(4):1358-1362.
[7]Marx G,Reinhart K.Venous oximetry[J].Curr Opin Crit Care,2006,122(3):263-268.
[8]Dellinger RP,Levy MM,Carlet JM,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock:2008[J].Crit Care Med,2008,36(1):296-327.
[9]龙怀聪,肖邦榕,刘跃建,等.162例成人重症肺炎临床特点及死亡危险因素分析[J].实用医院临床杂志,2011,8(4)75-78.