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目的探讨早期血乳酸清除率在判断心脏骤停后综合征(PCAS)患者预后的评估价值。方法回顾性分析96例心脏骤停自主循环恢复后收入ICU的患者临床资料,计算6h血乳酸清除率,同时进行APACHEⅢ评分及记录患者预后情况。根据患者入院72h转归情况,分成存活≤72h组和存活>72h组,按血乳酸清除率10%为界分成高乳酸清除率组(>10%)和低乳酸清除率组(≤10%或负值),比较各组间性别、年龄、血乳酸基础值、6h血乳酸值、6h血乳酸清除率、6h中心静脉血氧饱和度(ScvO2)、APACHEⅢ评分、休克指数等的差异性。对有统计学意义的变量进行多因素二元Logistic回归分析筛选出影响PCAS预后的独立危险因素,并绘制ROC曲线,比较危险因素曲线下面积大小。结果存活≤72h和存活>72h组在性别、年龄、血乳酸基础值、复苏6h内的APACHEⅢ评分等方面差异均无统计学意义(P>0.05);而存活>72h组的6h血乳酸清除率明显高于存活≤72h组[(32.72±15.56)%vs(21.47±18.08)%,P<0.01];高乳酸清除率组中存活>72h的比率明显高于低乳酸清除率组[73.24%vs28.00%,P<0.01]。多因素二元Logistic回归分析表明,6h血乳酸清除率、6h ScvO2是影响PCAS患者预后的独立危险因素;应用6h血乳酸清除率判断PCAS预后的ROC曲线下面积(AUC=0.830)较6hScvO2曲线下面积(AUC=0.729)大,差异有统计学意义(P<0.001),具有更好的特异度和灵敏度。结论早期血乳酸清除率可作为心脏骤停后综合征患者预后的评估重要且简便的指标之一。
Objective To investigate the prognostic value of early serum lactate clearance in predicting post-cardiac arrest syndrome (PCAS). Methods A retrospective analysis of 96 patients with ICU after spontaneous circulation recovery from cardioversion was performed. The 6h blood lactic acid clearance, APACHEⅢ score and prognosis were recorded. According to the outcome of 72h admission, the patients were divided into survival ≤72h group and survival> 72h group, divided into high lactic acid clearance group (> 10%) and low lactic acid clearance group (≤10% or Negative group). The differences of sex, age, basic blood lactate, 6h lactic acid, 6h lactic acid clearance, 6h central venous oxygen saturation (ScvO2), APACHEⅢ score and shock index were compared between groups. The multivariate Logistic regression analysis of statistically significant variables were used to screen out the independent risk factors that affect the prognosis of PCAS. The ROC curve was drawn to compare the area under the risk factor curve. Results There was no significant difference in gender, age, basal level of blood lactate, APACHEⅢ score within 6h after resuscitation (P> 0.05), while survival> 72h group and 6h survival rate (32.72 ± 15.56)% vs (21.47 ± 18.08)%, P <0.01]. The ratio of survival in high lactic acid clearance group> 72h was significantly higher than that in low lactic acid clearance group [73.24% vs28 .00%, P <0.01]. Multivariate Logistic regression analysis showed that the 6 h ScvO2 and 6 h ScvO2 were independent risk factors for prognosis of PCAS patients. The area under the ROC curve (AUC = 0.830) of 6 h blood lactic acid clearance was higher than that of 6 h ScvO2 curve Area (AUC = 0.729), the difference was statistically significant (P <0.001), with better specificity and sensitivity. Conclusion The early rate of blood lactate clearance can be used as one of the important and simple indexes to evaluate the prognosis of patients with post-cardiac syndrome.