中文摘要：

目的探讨动脉血乳酸清除率在脓毒症患者预后评估中的应用价值。方法回顾性分析2011年1月至2012年12月收入本科重症监护室（ICU）脓毒症患者的临床资料,执行事先制定的纳入和排除标准。根据预后将患者分为2组：存活组和死亡组。分析2组患者6h动脉血乳酸清除率的差异,观察其判断预后的受试者工作特征（ROC）曲线下面积,并寻找出预测脓毒症预后的最佳截断值。再根据最佳截断值分为高乳酸清除率组和低乳酸清除率组,比较两组患者之间乳酸、降钙素原（PCT）、APACHEⅡ评分、脓毒症相关器官功能障碍评分（SOFA）以及死亡率的差异。结果共计纳入84例脓毒症患者,其中存活组48例,死亡组36例。存活组和死亡组入院动脉血乳酸[（2.31±1.39）vs（3.93±1.84）mmol/L]及6h动脉血乳酸清除率[（44.01±27.37）%vs（10.49±24.53）%]差异均有统计学意义（P〈0.01）。动脉血乳酸清除率、APACHEⅡ及SOFA评分预测脓毒症预后的ROC曲线下面积分别为87.15%、77.89%和84.84%。在6h乳酸清除率为31%时,具有最高的约登指数（0.72）。将患者分为高乳酸清除率组（≥31%）和低乳酸清除率组（〈31%）,两组之间APACHEⅡ评分、SOFA评分及死亡率差异均有统计学意义（P〈0.05）。不同乳酸清除率是评价患者预后的独立风险因素（OR=0.021,95%CI 0.002~0.237,P=0.002）。结论动脉血乳酸清除率可以较好地预测脓毒症患者预后。

英文摘要：

Objective To study the prognostic value of arterial blood lactate clearance rate in patients with sepsis.Methods The clinical data of sepsis patients who were treated from January 2011 to December 2012 in our intensive care unit were retrospectively analyzed.They were divided into the survival group and the dead group according to different outcomes.The lactate clearance rates at 6hafter admission were compared between the two groups.The area under the ROC curve（AUC）was calculated and the best cut-off value of arterial blood lactate clearance was used to evaluate the prognosis of sepsis.Then the patients were divided into the high lactate clearance group and low lactate clearance group,and the values of lactate,procalcitonin（PCT）,acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score,sepsis-related organ failure assessment（SOFA）score and mortality were compared between the high and low lactate clearance groups.Results A total of84 patients were finally included in this study,with 48 in the survival group and 36 in the dead group.The levels of arterial blood lactate on admission（[2.31±1.39]mmol/L and[3.93±1.84]mmol/L,P〈0.01）and arterial blood lactate clearance rates at 6hafter admission（[44.01±27.37]% and[10.49±24.53]%,P〈0.01）were significantly different between the two groups.The AUC of lactate clearance rate,APACHEⅡ score and SOFA score were 87.15%,77.89% and 84.84% for predicting sepsis,respectively.The Youden Index reached the peak value（0.72）when the lactate clearance rate was 31%.The APACHEⅡ score,SOFA score and mortality rates were significantly different between the high lactate clearance rate group（≥ 31%）and the low lactate clearance rate group（〈31%,P〈0.05）.Lactate clearance rate was an independent risk factor of prognosis in sepsis patient（OR=0.021,95%CI 0.002-0.237,P=0.002）.Conclusion Arterial blood lactate clearance may serve as a promising index for predicting prognosis of sepsis.