The Value of Early Base Excess in Predicting the Severity of Septic Shock_West China Medical Journal

Authors：

YANG Mingquan , CHEN Yanmei

Intensive Care Unit, the First People’s Hospital of Zigong, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

Keywords：

感染性休克; 碱剩余; 病情程度; 预后

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目的　探讨早期碱剩余对感染性休克患者病情严重程度的预测价值。方法　对2009年2月－2011年2月资料完整入院的感染性休克患者60例进行回顾性分析，按死亡及存活进行分组，对最初24 h的碱剩余值差异及血乳酸清除率情况进行对照研究。结果　死亡组碱剩余值变化及乳酸清除率低于存活组（P＜0.05）。治疗后碱剩余≤−6 mmol/L较碱剩余＞−6 mmol/L的患者病死率明显增加，尤其是治疗后24 h 碱剩余仍≤−6 mmol/L病死率高达92.23%。结论　早期碱剩余有助于感染性休克预后评估和指导临床治疗。

Citation： YANG Mingquan,CHEN Yanmei. The Value of Early Base Excess in Predicting the Severity of Septic Shock. West China Medical Journal, 2012, 27(10): 1483-1486. doi: Copy

1.	Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis[J]. Intensive Care Med, 2010，36(2): 222-231.
2.	American College of Chest Physiciana/Society of Critical Care Medicine Consensus Confeernce. Definitionsforse psisa ndorgan failure and guidelines for the use of innovative therapies in sepsis[J]. Crit Care Med, 1992, 20(6): 864-874.
3.	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.
4.	Lee SW, Hong YS, Park DW, et al. Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients[J]. Emerg Med J, 2008, 25(10): 659-665．.
5.	Gunnerson KJ, Saul M, He S, et al. Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients[J]. Crit Care, 2006, 10(1): R22.
6.	Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial[J]. JAMA, 2010, 303(8): 739-746.
7.	徐向东, 吴健锋, 管向东, 等. 早期乳酸清除率评估外科严重脓毒症预后的临床价值研究[J]. 中国实用外科杂志, 2007, 27(12): 969-970．.
8.	杨明全, 曹建伟, 陈燕梅. 脓毒性休克早期液体复苏的临床反应性评价[J].华西医学, 2011, 26(6): 863-866.
9.	Palma LC, Ferreira GF，Amaral ACKB，et al．Acidosis and mortality in severe sepsis and septic shock evaluated by base excess variation [J]．Critical Care, 2003, 7(Suppl 3): 39.
10.	Allen M. Lactate and acid base as a hemodynamic monitor and markers of cellular perfusion[J]. Pediatr Crit Care Med, 2011, 12(4 Suppl): S43- S49.
11.	Surbatovic M, Radakovic S, Jevtic M, et al. Predictive value of serum bicarbonate, arterial base deficit/excess and SAPSⅢ score in critically ill patients[J]. Gen Physiol Biophys, 2009, 28: 271-276.
12.	Noritomi DT, Soriano FG, Kellum JA, et al. Metabolic acidosis in patients with severe sepsis and septic shock: a longitudinal quantitative study[J]. Crit Care Med, 2009, 37(10): 2733-2739.
13.	Park M, Azevedo LC, Maciel AT, et al. Evolutive standard base excess and serum lactate level in severe sepsis and septic shock patients resuscitated with early goal-directed therapy: still outcome markers[J]. Clinics (Sao Paulo), 2006, 61(1): 47-52.
14.	潘景业, 吴河水, 吴双华, 等. 碱剩余早期动态变化与严重脓毒症和脓毒症休克患者预后的关系[J]. 中国急救医学, 2009, 29(2): 100-102.
15.	Montassier E, Batard E, Segard J, et al. Base excess is an accurate predictor of elevated lactate in ED septic patients[J]. Am J Emerg Med, 2012, 30(1): 184-187.

1. 　Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis[J]. Intensive Care Med, 2010，36(2): 222-231.
2. 　American College of Chest Physiciana/Society of Critical Care Medicine Consensus Confeernce. Definitionsforse psisa ndorgan failure and guidelines for the use of innovative therapies in sepsis[J]. Crit Care Med, 1992, 20(6): 864-874.
3. 　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.
4. 　Lee SW, Hong YS, Park DW, et al. Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients[J]. Emerg Med J, 2008, 25(10): 659-665．.
5. 　Gunnerson KJ, Saul M, He S, et al. Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients[J]. Crit Care, 2006, 10(1): R22.
6. 　Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial[J]. JAMA, 2010, 303(8): 739-746.
7. 　徐向东, 吴健锋, 管向东, 等. 早期乳酸清除率评估外科严重脓毒症预后的临床价值研究[J]. 中国实用外科杂志, 2007, 27(12): 969-970．.
8. 　杨明全, 曹建伟, 陈燕梅. 脓毒性休克早期液体复苏的临床反应性评价[J].华西医学, 2011, 26(6): 863-866.
9. 　Palma LC, Ferreira GF，Amaral ACKB，et al．Acidosis and mortality in severe sepsis and septic shock evaluated by base excess variation [J]．Critical Care, 2003, 7(Suppl 3): 39.
10. 　Allen M. Lactate and acid base as a hemodynamic monitor and markers of cellular perfusion[J]. Pediatr Crit Care Med, 2011, 12(4 Suppl): S43- S49.
11. 　Surbatovic M, Radakovic S, Jevtic M, et al. Predictive value of serum bicarbonate, arterial base deficit/excess and SAPSⅢ score in critically ill patients[J]. Gen Physiol Biophys, 2009, 28: 271-276.
12. 　Noritomi DT, Soriano FG, Kellum JA, et al. Metabolic acidosis in patients with severe sepsis and septic shock: a longitudinal quantitative study[J]. Crit Care Med, 2009, 37(10): 2733-2739.
13. 　Park M, Azevedo LC, Maciel AT, et al. Evolutive standard base excess and serum lactate level in severe sepsis and septic shock patients resuscitated with early goal-directed therapy: still outcome markers[J]. Clinics (Sao Paulo), 2006, 61(1): 47-52.
14. 　潘景业, 吴河水, 吴双华, 等. 碱剩余早期动态变化与严重脓毒症和脓毒症休克患者预后的关系[J]. 中国急救医学, 2009, 29(2): 100-102.
15. 　Montassier E, Batard E, Segard J, et al. Base excess is an accurate predictor of elevated lactate in ED septic patients[J]. Am J Emerg Med, 2012, 30(1): 184-187.

West China Medical Journal

The Value of Early Base Excess in Predicting the Severity of Septic Shock

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