| Objective:1.To discuss whether critical patients with elavated blood lactic acid level had worse condition and prognosis.2.To study the correlation between blood lactic acid level and APACHEⅡscroing system.3.For ciritcal patients with elevated lactic acid level,to study and quantify the relationship between dynamic lactic acid monitoring indexes and prognosis of ICU critical patients.Methods:1.93 critical patients with definite prognosis who met the selected criteria were were included in this study and were divided into group 1(58 patients with elavated lactic acid level) and group 2(35 patients with continous normal lactic acid level). Differences of mortality,incidence of MODS and shock,APACHEⅡscore between two groups were compared.2.The patients were divided into 3 groups by APACHEⅡscore(<15 points,15 to 25 points,≧25 points,respectively) to compare pathogenetic conditions and prognosis,then to study the correlation between blood lactic acid values and APACHEⅡscoring system.3.58 ciritcal patients with elevated lactic acid level were divided into death group and survival group by the hospital prognosis.Differences of their lactic indexes (including:lactic acid level,lactime,lactic clearance) and other clinical indicators which reflected organ/system status were compared,prognostic-significant lactic indexes were selected by multi-variable logistic analysis.Subsequently,patients were grouped by significant lactic indexes separately and compared with pathogenetic conditions and prognosis.Results:1.Patients with elavated lactic acid level had more incidence of shock and MODS,higher APACHEⅡscores and mortality(67.20%vs 20.00%),the differeces had statistical significance compared with the normal lactic acid group(P<0.05).2.With increased APACHEⅡscore,the incidence of shock and hospital mortality increased subsequently,differeces between consecutive groups had statistical significance(P<0.05).Patients also had significantly increased lactate levels along with increased APACHEⅡscore:the peak lactic acid level were 2.64±2.90,5.50±4.93,8.52±4.42(mmol/L),differeces between consecutive groups had statistical significance(P<0.01).There were significant linear correlation between ICU lactic acid level,peak lactic acid level and APACHEⅡscores respectively(r=0.455,0.504, P<0.01).3.For the patients with elevated lactic acid level,differences of ICU lactic acid level,peak lactic acid level,12h and 24h lactic clearance between death group and survival group had statistical significance(P<0.05),differences of lactime between two groups had no statistical significance(P>0.05).Peak lactic acid level,12h lactic clearance,APACHEⅡscore and PH had significant correlation with prognosis,the OR and 95%CI were 1.861(1.152—3.083),0.807(0.724—0.941),1.351(1.199—1.563),0.056(0.003—0.682),respectively.Patients with peak lactic acid value≧10mmol/L or lactic clearance≦10%had significantly higher mortality, 91.30%and 93.33%,respectively(P<0.05).Although patients with lactime>24h had higher mortality,but the difference had no statistical significance(P>0.05). Conclusion:ICU critical patients with elavated blood lactic acid level had worse condition and prognosis.APACHEⅡscoring system could assess the patient's condition and prognosis effectively and also had a significant linear correlation with lactic acid level, all of which prompted the important value of blood lactic acid level in the prognosis evaluation of cirtical patients.For the patients with elevated lactic acid level due to disturbance of tissue perfusion,peak lactic acid level,12h lactic clearance,APACHEⅡscore and PH are good indicators to evaluate patients' prognosis.Peak lactic acid value≧10mmol/L or lactic clearance≦10%is a alert of extremely bad prognosis. The prognosis value of lactime is limited.Dynamic monitoring of blood lactic acid should be conducted as soon as possible in critical patients after ICU admission,even at the emergency.First-hand information of lactic acid is important to guide treatment,improve the tissue hypoixa and decrease mortality. |
PDF Full Text Request