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目的:探讨血乳酸(Lac)持续增高时间在脓毒血症患者预后评估中的临床价值。方法:回顾性分析2016年1月至2018年12月兰州市第一人民医院重症医学科收治的脓毒血症患者84例。根据患者最终转归情况分为死亡组和存活组，比较两组患者一般情况、初始血乳酸(Lac)，6、12、18、24 h Lac，Lac>2 mmol/L持续时间(Tn Lac>2)。利用ROC曲线分析性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ)、初始Lac、6、12、18、24 h Lac、Tn Lac>2在评估脓毒血症患者预后的灵敏度及特异度；同时将这些参数与患者预后的关系进行COX回归分析，评估血乳酸持续增高时间在脓毒血症患者预后的临床价值。n 结果:两组患者年龄、性别、APACHE Ⅱ评分及初始Lac比较差异无统计学意义(n P>0.05)。死亡组治疗后6、12、18、24 h Lac均高于存活组(n P2明显长于存活组(n P2与患者生存率、死亡风险明显相关，Tn Lac>2越长，生存率越低，死亡风险越高。同时利用ROC曲线进行分析，患者性别、年龄、APACHE Ⅱ评分及初始Lac的AUC显示，这些指标不能有效评价患者预后(n P>0.05)。Tn Lac>2曲线下面积最大，评价预后效能最佳，24 h Lac次之，18、12、6 h Lac依次递减。此外Tn Lac>2、24、18、12、6 h Lac用于脓毒血症死亡风险评估的灵敏度分别为90.9%、81.8%、81.8%、81.8%、88.6%；特异度分别为71.4%、52.5%、52.5%、47.7%、25.5%。n 结论:一过性的乳酸增高不能评价脓毒血症患者的预后，但乳酸>2 mmol/L持续增高时间对脓毒血症患者预后有着显著影响。乳酸持续增高的时间(Tn Lac>2)越长，患者生存率越低，死亡风险越高。利用乳酸持续增高时间来评价患者死亡风险的灵敏度及特异度均高于其他参数，其评价预后效能最佳。n “,”Objective:To investigate the clinical value of continuous increase of blood lactic acid (Lac) in prognosis evaluation of patients with sepsis.Methods:From January 2016 to December 2018, 84 patients with sepsis in the Department of Critical Medicine of Lanzhou First People's Hospital were retrospectively analyzed. According to the final outcome, the patients were divided into death group and survival group. The general condition, initial Lac, Lac at 6, 12, 18, 24 h, and the duration of Lac>2 mmol/L (Tn Lac>2) were compared between the two groups. Receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), initial lac, 6, 12, 18, 24 h lac, Tn Lac>2 in evaluating the prognosis of patients with sepsis. At the same time, the relationship between these parameters and the prognosis of patients was analyzed by Cox regression analysis to evaluate the clinical value of the time of continuous increase of blood lactate in the prognosis of patients with sepsis.n Results:There was no significant difference in age, gender, APACHE Ⅱ score and initial lac between the two groups (n P>0.05). The Lac of death group was higher than that of survival group at 6, 12, 18 and 24 h after treatment (n P2 in death group was significantly longer than that in survival group (n P2 was significantly correlated with survival rate and death risk. The longer Tn Lac>2 was, the lower the survival rate and the higher the risk of death. At the same time, ROC curve analysis showed that gender, age, APACHE Ⅱ score and area under the curve (AUC) of initial lac showed that these indicators could not effectively evaluate the prognosis of patients (n P>0.05). The area under the curve of Tn Lac>2 was the largest, and the evaluation of prognosis was the best, followed by 24 h Lac and 18 h, 12 h and 6 h Lac. In addition, the sensitivity of Tn Lac>2, 24, 18, 12, 6 h for sepsis mortality risk assessment were 90.9%, 81.8%, 81.8%, 81.8%, 88.6%, and the specificity were 71.4%, 52.5%, 52.5%, 47.7% and 25.2%, respectively.n Conclusions:Transient increase of lactic acid can not evaluate the prognosis of patients with sepsis, but the duration of lactic acid increase has a significant impact on the prognosis of patients with sepsis. The longer the increase of Lactic acid (Tn Lac>2) is, the lower the survival rate and the higher the risk of death. The sensitivity and specificity of lactic acid duration in evaluating the risk of death were higher than those of other parameters, and the prognostic efficacy was the best.n