Correlation Analysis Of Serum Lactate Dynamic Monitoring And Early Lactate Clearance With Prognosis Of Severe Traumatic Brain Injury

Objective:By reviewing the blood lactate levels and early lactic acid clearance in patients with severe traumatic brain injury,we can explore the role of blood lactate monitoring and lactic acid clearance in the prognosis of severe craniocerebral trauma.Methods:1.A total of 79 patients with severe craniocerebral injury admitted to the Department of Neurology,Hebei Provincial People’s Hospital from December 2015 to December 2016 were selected.Inclusion criteria:(1)Traumatic brain injury within 6 h admission;(2)GCS score 3 to 8 on admission;(3)All patients were diagnosed by skull CT or MRI;(4)Adult(> 18 years old).Exclusion criteria:(1)Merger of other important organs serious injury;(2)Patients with severe diseases who have important organs in the past;(3)Patients with undefined traumatic time;(4)Hospital died or abandoned treatment within 48 hours;(5)Incomplete case of clinical data.2.We deal with severe patients according to the treatment principle of severe craniocerebral trauma,given the department of NICU,oxygen inhalation,necessary endotracheal intubation,ventilator assisted breathing,application of hemostatic drugs,dehydration reducing intracranial pressure,fluid infusion,maintain blood pressure,maintain cerebral perfusion,anti infection,maintain water electrolyte and acid-base balance,nutritional support and symptomatic supportive treatmentPatients who meet the indications of surgery receive consents from the families of patients and receive surgical treatment according to different types of traumatic brain injury,such as brain contusion and laceration removal,intracranial hematoma removal,and skull decompression.3.We recorded the general data of all the patients,the acute physiological and chronic health score II system(APACHEII)score,and the GCS score.After admission,the arterial blood 2ml was measured immediately as the initial arterial lactate,and the lactate levels of 6h,12 h,24h and 48 h were monitored,and the early blood lactate clearance rate was calculated.(6h)Early lactate clearance =(initial blood lactate-6h blood lactate at admission)/initial blood lactate value × 100%4.According to the early lactic acid clearance rate,the patients were divided into early lactic acid clearance≥10% of the high lactic acid clearance group of 50 patients,and early lactic acid clearance rate of <10% of the low lactic acid clearance group of 29 patients;according to within 1 month The prognosis was divided into survival group 54 cases and death group 25 cases.Results:1.There was no significant difference in age and sex between patients with different lactic acid clearance rates(P> 0.05).Patients with low lactate clearance rates had lower GCS scores,higher APACAHE II scores,and higher mortality than those with high lactate clearance rates.(P <0.05).2.There was no difference in gender and age between death group and survival group(P> 0.05).Compared with the survival group,GCS score,APACAHEⅡ score and early lactic acid clearance rate in the death group were lower(P <0.05).Blood lactate levels were higher than normal in both groups after admission,and blood lactate levels were higher in death group than in survival group at each time point(P <0.05).After treatment,blood lactic acid levels in both groups showed a downward trend,compared with the survival group,the high blood lactate levels in the death group lasted longer,more slowly.3.The early lactic acid clearance rate in sTBI patients was positively correlated with admission GCS score(r = 0.677,P <0.05)and negatively correlated with APACHE II score(r =-0.610,P <0.05).Conclusion:1.Blood lactic acid levels in patients with severe head injury have increased to varying degrees,dynamic monitoring of blood lactate levels can be used to assess patient development trends,the early blood lactate clearance is an effective reference index for evaluating the prognosis of severe brain injury,and guiding early intervention is beneficial to improve the prognosis.2.The higher the level of blood lactate increase,the longer the duration,the lower the rate of early lactate clearance,the heavier the damage,and the worse the prognosis.3.The dynamic monitoring of blood lactic acid has the advantages of simple,rapid,convenient and low cost acquisition,and has certain clinical promotion value.