重症脓毒症患者动态监测血乳酸及 D-二聚体的临床研究_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

黄顺伟 ,  管向东

Corresponding author：

管向东, Email: carlg@163.com

Keywords：

重症脓毒症; 全身炎症反应综合征; 乳酸; D-二聚体

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目的动态观察外科重症脓毒症患者血清血乳酸及D-二聚体水平与预后的关系。方法回顾性分析55 例符合重症脓毒症标准的患者, 比较8、16、24、48、72 和168 h 的血乳酸变化和24、72、 168 h的D-二聚体变化。结果其中34 例存活, 21 例死亡, 死亡率为38. 2%, 均死于多器官功能衰竭。 34 例存活组血乳酸48 h 内均达到正常, 而21 例死亡组直至第168 h仍明显高于存活组和正常值( P lt; 0. 05) 。死亡组24 h D-二聚体水平比存活组明显升高( 为正常值的5 倍) ( P lt;0. 05) , 在72 和168 h 两组无显著差异( P gt;0. 05) , 但两组D-二聚体仍明显升高( 为正常值的2. 5 倍) 。若以24 h 血乳酸和24 h D-二聚体预测死亡能力作ROC 曲线,24 h 血乳酸和D-二聚体的预测死亡能力相当。结论动态监测1 周内血乳酸水平是判断重症脓毒症患者预后的一个重要指标, 血乳酸48 h 内降至正常, 预后良好; 随后的血乳酸仍高于正常, 预后差。24 h 血乳酸水平与24 h D-二聚体水平预测死亡能力相当。

Citation： 黄顺伟,管向东. 重症脓毒症患者动态监测血乳酸及 D-二聚体的临床研究. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(5): 492-494. doi: Copy

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4.	管向东, 寇秋野. 感染性休克血流动力学的监测指标. 创伤外科杂志, 2007, 8: 97-99.
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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.
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10.	, No.
11.	齐云晓, 刘敏涓, 叶絮, 等. 脓毒症患者血栓前体蛋白测定的临床价值探讨. 血栓与止血学, 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.

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. 管向东, 寇秋野. 感染性休克血流动力学的监测指标. 创伤外科杂志, 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. 王晓芝, 吕长俊, 高福全, 等. 目标指导下治疗脓毒性休克的疗效观察. 中国危重病急救医学, 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 中国呼吸与危重监护杂志2009 年9 月第8 卷第5 期Chin J Respir Crit Care Med, September 2009, Vol.
10. , No.
11. 齐云晓, 刘敏涓, 叶絮, 等. 脓毒症患者血栓前体蛋白测定的临床价值探讨. 血栓与止血学, 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.

Chinese Journal of Respiratory and Critical Care Medicine

重症脓毒症患者动态监测血乳酸及 D-二聚体的临床研究

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