The Relation Research Of Bedside Arterial Lactate Levels And The Emergency Critically Ill Patients、nursing Activities

Objective:Study the bedside arterial blood lactic acid (LAC) levels and the acute physiology and chronic health evaluation (APACHE Ⅱ) correlation of emergency critically ill patients, in order to find the relationship between LAC levels and the nursing workload requirements. To investigate the evaluation of the level of rapid bedside lactic acid detection, to predict the prognosis of the disease in critically ill patients in emergency department(ED), in order to correlate nursing workload requirements of LAC and the different groups of critically ill patients.Methods:To measure the bedside rapid detection of lactic acid of139critically ill patients accepted in emergency department of the ER of the first People’s Hospital of Hangzhou From Oct1st2012to Apr302013.In each patient, the level of the blood lactic acid was measured right at admission. The patients were divided into3groups:normal group (group A lactic acid, light in the elevated group B group and severe group increased C group), according to the different lactic acid level. APACHE Ⅱ score, the first24h nursing workload,1intubation rate, ICU occupancy rate and the28day mortality were collected24hours after admission in all three groups. APACHE Ⅱ scoring software, nursing activities score (Nursing Activities, Score, NAS) inventory, Roche Cobos B221bedside blood gas analyzer were used for information acquisition. Statistical analysis was performed with SPSS19.0statistical software the area under the ROC curve (AUC) test the predict the outcomes of the patients.Results:1. Different lactic acid level of patients (P<0.05). The LAC level of A group was1.226±0.364mmol/L, APACHE Ⅱ score17.81±4.571, LAC level of B group was2.753±0.549mmol/L, APACHE Ⅱ score12.12±4.833, LAC level of C group was7.578±2.236mmol/L, APACHE Ⅱ score29.85±3.625. Significant difference were found in the three groups.with the rate of intubation, ICU occupancy rate, and the mortality (P<0.05).Arterial blood lactate levels and APACHE Ⅱ correlation analysis, r=0.604, P=0.000.2. Patients with different prognosis grouping of blood lactic acid level, APACHE Ⅱ score value, including30cases of intubation, LAC4.307±3.127mmol/L, APACHE Ⅱ score26.50±4.967, no case ofl intubation in109patients, LAC1.934±1.055mmol/L, APACHE Ⅱ score19.11±4.967; in ICU32patients, LAC levels of4.556±2.923mmol/L, APACHE Ⅱ score19.11±4.967, ward107, LAC1.815±0.901mmol/L, APACHE Ⅱ score19.34±5.174; The death of28days in18cases, LAC4.972±3.091mmol/L, APACHE Ⅱ score25.44±5.953,121survived cases, the level of LAC2.070±1.420mmol/L, APACHE Ⅱ score20±5.476, the difference was statistically significant (P<0.05).3. Arterial lactate levels and APACHE Ⅱ score prediction analysis, ROC curve of death, APACHE Ⅱ score predicts mortality in high capacity (AUC=0.752, P<0.001), the value of the prediction of the LAC was higher (AUC=0.839, P<0.001).4. Different arterial blood lactate levels in patients with NAS score, NAS score was38.890±11.931in group A, group B is45.396±12.192, C group62.623±13.317respectively, with statistically significant difference (P<0.05).Conclusion:1. Bedside arterial lactate level and APACHE Ⅱ score correlated, were good predicters tovalue the severity and prognosis of critically ill patients.2. Bedside arterial lactate level has relationship with patients’outcomes to evaluate the severity of the emergency critical care. Which is much more convenient than APACHE. Bedside lactic acid determination results only taking2minutes, which is suitable for emergency medical personnel as soon as possible find out how gravely ill condition and implementation of early treatment intervention.3. Bedside correlated with arterial lactate level and nursing workload. Lactic acid levels is a good predictor of the evaluation of nursing workload.