重癥膿毒癥患者動態監測血乳酸及 D-二聚體的臨床研究_《中國呼吸與危重監護雜志》

作者：

黃順偉 ,  管向東

中山大學附屬第一醫院外科重癥監護中心(廣東廣州 510080);

關鍵詞：

重癥膿毒癥全身炎癥反應綜合征乳酸 D-二聚體

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目的動態觀察外科重癥膿毒癥患者血清血乳酸及D-二聚體水平與預后的關系。方法回顧性分析55 例符合重癥膿毒癥標準的患者, 比較8、16、24、48、72 和168 h 的血乳酸變化和24、72、 168 h的D-二聚體變化。結果其中34 例存活, 21 例死亡, 死亡率為38. 2%, 均死于多器官功能衰竭。 34 例存活組血乳酸48 h 內均達到正常, 而21 例死亡組直至第168 h仍明顯高于存活組和正常值( P lt; 0. 05) 。死亡組24 h D-二聚體水平比存活組明顯升高( 為正常值的5 倍) ( P lt;0. 05) , 在72 和168 h 兩組無顯著差異( P gt;0. 05) , 但兩組D-二聚體仍明顯升高( 為正常值的2. 5 倍) 。若以24 h 血乳酸和24 h D-二聚體預測死亡能力作ROC 曲線,24 h 血乳酸和D-二聚體的預測死亡能力相當。結論動態監測1 周內血乳酸水平是判斷重癥膿毒癥患者預后的一個重要指標, 血乳酸48 h 內降至正常, 預后良好; 隨后的血乳酸仍高于正常, 預后差。24 h 血乳酸水平與24 h D-二聚體水平預測死亡能力相當。

引用本文： 黃順偉,管向東. 重癥膿毒癥患者動態監測血乳酸及 D-二聚體的臨床研究. 中國呼吸與危重監護雜志, 2009, 09(5): 492-494. doi: 復制

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1. Levy MM, Fink MP, Marshall JC, et al.
2. James JH, Luchette FA, Mccarter FD, et al. Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet, 1999, 354 : 505-508.
3. Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med, 2004 , 32 : 1637-1642.
4. 管向東, 寇秋野. 感染性休克血流動力學的監測指標. 創傷外科雜志, 2007, 8: 97-99.
5. Gando S, Nanzaki S, Sasaki S, et al. Activation of the extrinsic coagulation pathway in patients with severe sepsis and septic shock. Crit Care Med, 1998, 26: 2005-2009.
6. 王曉芝, 呂長俊, 高福全, 等. 目標指導下治療膿毒性休克的療效觀察. 中國危重病急救醫學, 2006, 18, 661-664.
7. ·493· ? 2002-2009 Editorial Department of Chinese Journal of Respiratory and Critical Care Medicine. All rights reserved. Http://www.cjrccm.com medicine: best BETs from the Manchester Royal Infirmary. Bet 1 . Lactate clearance a better predictor of mortality than initial lactate level lactate clearance a better predictor of mortality than initial lactate level. Emerg Med J, 2008, 25: 593-594.
8. Corley KT, Donaldson LL, Furr MO. Arterial lactate concentration, hospital survival, sepsis and SIRS in critically ill neonatal foals. Equine Vet J, 2005, 37 : 53 -59.
9. Gnanasegaram D, Hugher N. Towards evidence based emergenay 中國呼吸與危重監護雜志2009 年9 月第8 卷第5 期Chin J Respir Crit Care Med, September 2009, Vol.
10. , No.
11. 齊云曉, 劉敏涓, 葉絮, 等. 膿毒癥患者血栓前體蛋白測定的臨床價值探討. 血栓與止血學, 2008, 14: 105-107.
12. Voves C, Wuillemin WA, Zeerleder S. International Society on Thrombosis and Haemostasis score for overt disseminated intravascular coagulation predicts organ dysfunction and fatality in sepsis patients. Blood Coagul Fibrin Olysis, 2006, 17: 445-451.
13. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med, 2001, 344: 699-709.
14. SCCM/ESICM/ACCP/ ATS /SIS international sepsis definitions conference. Crit Care Med, 2003, 31: 1250-1256.

《中國呼吸與危重監護雜志》

重癥膿毒癥患者動態監測血乳酸及 D-二聚體的臨床研究

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《中國呼吸與危重監護雜志》

重癥膿毒癥患者動態監測血乳酸及 D-二聚體的臨床研究

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