多发伤患者初始血乳酸及休克指数与短期预后的相关性分析

目的血乳酸及不同休克指数均是临床上判断多发伤患者预后的重要指标。文中旨在探讨初始血乳酸及不同休克指数与多发伤患者预后的相关性,分析不同休克指数联合初始血乳酸对多发伤患者预后的评估价值。方法收集2017年1月至2018年6月东部战区总医院急诊科收治的351例多发伤的患者临床资料。根据治疗结局将患者分为存活组和死亡组;按照rSIG(GCS/SI)的截断值11.1分为低rSIG组和高rSIG组。比较各组基本生命体征、休克指数(SI)、初始血乳酸、28 d病死率等指标。比较SI、rSIG、初始血乳酸与多发伤患者预后的相关性。结果存活组患者rSIG值显著大于死亡组[20.5(15.0,26.3)vs 7.8(4.9,12.6),P<0.01]、初始血乳酸水平显著低于死亡组[1.7(1.1,2.8)mmol/L vs 2.9(2.0,7.5)mmol/L,P<0.01];rSIG≤11.1患者初始血乳酸水平[2.4(1.5,5.2)mmol/L]、抢救时间[1.0(1.0,3.0)d]、重症监护住院时间[13.0(4.0,24.0)d]以及28 d死亡率(33.3%)均显著大于rSIG>11.1患者[1.7(1.1,2.7)mmol/L、1.0(1.0,1.0)d、1.0(0.0,9.5)d和3.2%],差异均有统计学意义(P<0.05)。多发伤患者rSIG与初始乳酸水平呈负相关(r=-0.364,P<0.00);rSIG与初始血乳酸联合对患者28 d病死率的判断能力(AUC=0.832)优于单独初始血乳酸(AUC=0.739)、SI(AUC=0.598)、rSIG(AUC=0.809)、SI联合血乳酸(AUC=0.732)。结论rSIG与初始血乳酸水平联合对多发伤患者预后的预测能力最佳。rSIG同多发伤患者短期预后的相关性最为密切。

Objective Blood lactic acid and different shock indexes are important indicators for clinicaljudgment of the prognosis of patients with multiple injuries.The purpose of this article is to explore the correlation of the initial blood lactate and different shock indexes,and to analyze the evaluation value of different shock indexes combined with initial blood lactate on the prognosis of patients with multiple injuries.Methods The 351 patients diagnosed with multiple injuries admitted to the emergency department of the Eastern Theater General Hospital from January 2017 to June 2018 were included.They were divided into survival group and death group by the outcome and were divided into low rSIG group and high rSIG group by the best cut-off value 11.1 of rSIG shock index(The reverse shock index(rSI)multiplied by Glasgow Coma Scale(GCS)score,rSIG).The basic vital signs,rSIG shock index(rSIG=GCS/SI),shock index(shock index,SI),initial blood lactate,28-day mortality rate and other indicators of each group were analyzed.The correlation of SI,rSIG,initial blood lactic acid and the prognosis of patients with multiple injuries was compared.Results The rSIG value ofthe survival group was significantly higher than that of the death group[20.5(15.0,26.3)vs 7.8(4.9,12.6),P<0.00],and the initial blood lactate level was significantly lower than that of the death group[1.7(1.1,2.8)mmol/L vs 2.9(2.0,7.5)mmol/L,P<0.00];The initial blood lactic acid level,the number of rescue days,the number of intensive care days,and the 28-day mortality rate of the patients in the rSIG≤11.1 group were significantly higher than those in the rSIG>11.1 group[2.4(1.5,5.2)mmol/L vs 1.7(1.1,2.7)mmol/L,P<0.01,1.0(1.0,3.0)d vs 1.0(1.0,1.0)d,P<0.01,13.0(4.0,24.0)d vs 1.0(0.0,9.5)d,P<0.01,33.3%vs 3.2%,P<0.01];The rSIG in patients with multiple injuries was negatively correlated with the initial lactate level(r=-0.364,P<0.00);The clinical judgment of the combination of rSIG and initial blood lactate(AUC=0.832)is better than initial blood lactate alone(AUC=0.

作者张鹏王蒙蒙孙兆瑞杨志洲董妍庄苏园聂时南ZHANG Peng;WANG Meng-meng;SUN Zao-rui;YANG Zhi-zhou;DONG Yan;ZHUANG Su-yuan;NIE Shi-nan(Department of Emergency Medicine,Jinling Hospital,Nanjing University School of Medicine/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区南京大学医学院附属金陵医院（东部战区总医院）急救医学科

出处《医学研究生学报》 CAS 北大核心 2021年第4期399-404,共6页Journal of Medical Postgraduates

关键词rSIG休克指数乳酸多发伤预后rSIG shock index lactic acid multiple injuries prognosis

分类号R641 [医药卫生—外科学]