The Study Of Early Change Of Serum Lactic Acid Level After Cardiopulmonary Resuscitation And Clinical Value For Prognosis

Objective:To mainly explore the correlation between the dynamic change trend of lactic acid level at the early stage after cardiopulmonary resuscitation(CPR)and prognosis evaluation,so as to provide a preliminary theoretical basis and direction for early disease monitoring and treatment after CPR.Methods:Twenty-one patients who were send to the emergency department and were observed in the emergency intensive care unit(EICU)of the people’s hospital of Liaoning province from the year of 2018 to the year of 2020 were selected,including 14 males and 7 females,all of them were returned of spontaneous circulation through CPR and survived more than 6 hours.Divide all the patients into survival group of 12 cases and death group of 9cases according to different prognosis after spontaneous circulation recovery near 3 days.All the patients received routine rescue operation,symptomatic support treatment and active treatment for primary diseases.Record the statistics of sex,age,resuscitation time,initial value of NT-pro BNP after resuscitation,history of basic diseases(including hypertension,diabetes,etc.),and survival time of all patients.After circulation resumed,femoral artery blood was collected at 0 h(initial immediate),3 h,6 h,12 h,24 h,48 h and 72 h,respectively.The changes of early blood lactic acid level were indicated by the lactate clearance rate in each time period which was calculated lactic acid scavenging formula.Register the heart rate,systolic blood pressure,body temperature and respiratory rate of all patients at the early stage of resuscitation,evaluate the condition of consciousness,and calculate the MEWS score for each patient.The patients’ body temperature were measured by an electronic thermometer,and there were no fever cases among the patients.Heart rate and systolic blood pressure were measured using an electronic blood pressure monitor.The respiratory rate measured by bedside ECG monitor was compared with the statistical value of ventilator.The difference between the two groups was compared to see if there was a significant difference between the indicators,and the ability of the indicators with significant differences to evaluate the prognosis and the degree of influence were retrospectively analyzed.The t test was used to analyze the measurement data that conform to the normal distribution,and the non-parametric test was used for the measurement data that do not conform to the normal distribution,while Fisher’s exact test usually used for the qualitative data.Using the Spearman rank correlation analysis to analyze the correlation between lactate clearance rate and MEWS scores within every time period.Spearman rank correlation analysis and binary multivariate logistic regression analysis were used to make research for the relevance among lactate clearance rate,modified early warning risk score and prognosis,with P<0.05 indicated statistically significant difference.The ROC curve was used to analyze lactate clearance rate and MEWS score to evaluate the prognostic value.P<0.05 and AUC>0.5 indicated statistically significant.Results:The lactic acid clearance rate in the survival group was significantly higher than that in the death group at each time period,especially the 3h lactic acid clearance rate and 6h lactic acid clearance rate were conspicuously different between the two groups(P<0.05).Lactate clearance rate at 3h can be intended for an independent predictor of the outcome after resuscitation(P<0.05,OR value >1),which has more reference value compared with the change of lactate level at other time points within 3 days,and may be used as an independent predictor of death in the recovery period after cardiopulmonary resuscitation.The lower the clearance rate of 3h lactic acid,the higher the possibility of poor prognosis and outcome.Conclusions:The early variance of lactic acid levels(take lactic acid clearance rate into consideration)was more superior than other interrelated indexes in assessing the extent and prognosis of patients after recovery of circulation.Lactic acid clearance rate at 3h may be used as a independent factor to predict the short-time prognosis of ROSC.It is more convenient and quicker to measure early lactic acid level and calculate lactic acid clearance rate for judging prognosis of patients after cardiopulmonary resuscitation,so as to facilitate early intervention and guide the direction of treatment.