急性呼吸窘迫综合征患者血乳酸定量分层临床价值.doc

急性呼吸窘迫综合征患者血乳酸定量分层临床价值[摘要] 目的：通过乳酸（LAC）定量分层观察急性呼吸窘迫综合征（ARDS）患者病情危重程度及预后的差异。方法：选取我院ICU收治并诊断为ARDS患者104例，每6小时抽取动脉血做血气分析，根据48 h内乳酸值求和后取平均值将患者分以下四组：对照组[LAC（3.2±1.7）mmol/L]；观察组A[（7.1±2.1）mmol/L]；观察组B[（11.5±2.3）mmol/L]；观察组C[（15.8±2.0）mmol/L]，并比较各组同一时间的肺泡-动脉氧分压差[P（A-a）DO2]、氧合指数（PaO2/FiO2）以及患者的APACHEⅡ评分。评定每组患者病情危重程度及预后情况。结果：所有ARDS患者LAC定量均增高，且LAC定量与APACHEⅡ评分、P（A-a）DO2呈正相关（r=0.79，P＜0.05），与病死率呈正相关（r=0.78，P＜0.05），与PaO2/FiO2呈负相关（r=-0.76，P＜0.05）。观察组患者病情较对照组病情重，预后更差。结论：LAC定量值与ARDS病情严重程度呈正相关，是观察ARDS严重程度与转归的重要指标。 [关键词] 乳酸；定量；分层；急性呼吸窘迫综合征 [中图分类号] R56 [文献标识码] Ａ [文章编号] 1673-7210（2011）12（b）-034-03 Clinical value of lactic acid quantitative stratification in acute respiratory distress syndrome patients RAO Huiqing, MO Beixi, HUANG Daoyong Department of ICU, Yangjiang People’s Hospital, Guangdong Province, Yangjiang 529500, China [Abstract] Objective: To observe the difference of critical condition and prognosis about acute respiratory distress syndrome (ARDS) patients by lactic acid (LAC) quantitative stratification. Methods: Arterial blood gas analyses of 104 ARDS patients were determined every 6 hours in ICU. Patients were divided into control group [(3.2±1.7) mmol/L], observation group A [(7.1±2.1) mmol/L], observation group B [(11.5±2.3) mmol/L], observation group C [(15.8±2.0) mmol/L] with different blood lactate average concentration in 48 hours. The difference of the alveolar-arterial oxygen difference [P(Aa)DO2], oxygenation index (PaO2/FiO2) and APACHE Ⅱ score at the same time were investigated between the four groups. Critical condition and prognosis of each group patients were assessed. Results: Blood lactate concentration of all ARDS patients were high, and lactate concentration was significantly positively correlated with APACHE Ⅱ score, P(A-a) DO2（r=0.79, P＜0.05), mortality（r=0.78, P＜0.05); and negatively correlated with PaO2/FiO2（r=-0.76, P＜0.05). Condition of Observation group patients were more serious than control group ones, with worse prognosis. Concl