本文關(guān)鍵詞：早期乳酸面積與成人膿毒癥患者預(yù)后相關(guān)性的研究　出處：《河南科技大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

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【摘要】：目的:通過(guò)對(duì)膿毒癥患者入院后24小時(shí)內(nèi)的動(dòng)脈血乳酸水平進(jìn)行動(dòng)態(tài)監(jiān)測(cè),分析早期乳酸面積與膿毒癥患者病情嚴(yán)重程度和預(yù)后的相關(guān)性及其臨床意義。方法:采用單中心、前瞻性研究的方法,選取2015年9月至2016年12月河南科技大學(xué)第一附屬醫(yī)院急診重癥監(jiān)護(hù)病房收治的符合納入及排除標(biāo)準(zhǔn)的成人膿毒癥患者進(jìn)行研究。收集入組患者基本臨床資料并動(dòng)態(tài)監(jiān)測(cè)生命體征變化。所有入組患者分別于入院時(shí)采集靜脈血行血常規(guī)、血凝、肝腎功能等實(shí)驗(yàn)室檢測(cè)。于入院時(shí)和入院第6、12、18、24小時(shí)采集動(dòng)脈血行動(dòng)脈血?dú)夥治�。利用所記錄血�(dú)夥治鼋Y(jié)果中動(dòng)脈血乳酸濃度數(shù)據(jù)及采血時(shí)間,根據(jù)乳酸清除率計(jì)算公式對(duì)6小時(shí)乳酸清除率進(jìn)行計(jì)算。將動(dòng)脈血乳酸濃度-時(shí)間數(shù)據(jù)以(x=時(shí)間,y=乳酸濃度)標(biāo)記于平面直角坐標(biāo)系中,以直線(xiàn)連接各點(diǎn),利用梯形面積計(jì)算公式分別計(jì)算0-6h、6-12h、12-18h、18-24h的“濃度-時(shí)間”下面積。將以上結(jié)果進(jìn)行求和從而得出各入組患者入院后第1個(gè)24小時(shí)內(nèi)的早期乳酸面積。根據(jù)所記錄生命體征和檢測(cè)指標(biāo)的最差值對(duì)患者入院第1天的APACHEⅡ和SOFA評(píng)分進(jìn)行計(jì)算。所有患者均按照膿毒癥治療的相關(guān)指南的推薦進(jìn)行綜合治療。依據(jù)隨訪(fǎng)28天的生存情況,將所有入組患者分為存活組和死亡組。比較存活組與死亡組之間基本臨床資料、血常規(guī)、肝腎功能、入院初始乳酸濃度、6小時(shí)早期乳酸清除率、入院第1個(gè)24小時(shí)的早期乳酸面積、APACHEⅡ評(píng)分、SOFA評(píng)分的差異。分析入院初始乳酸濃度、6小時(shí)乳酸清除率、早期乳酸面積與APACHEⅡ評(píng)分、SOFA評(píng)分之間的相關(guān)性。應(yīng)用Logistic回歸分析,對(duì)包括上述入院時(shí)乳酸濃度、早期乳酸面積、APACHEⅡ評(píng)分等預(yù)后相關(guān)因素進(jìn)行分析。繪制ROC曲線(xiàn)對(duì)早期乳酸面積、APACHEⅡ評(píng)分等與膿毒癥患者預(yù)后相關(guān)性進(jìn)行評(píng)估。結(jié)果:共納入120例患者,其中男性66例,女性54例。研究結(jié)果顯示:1.存活組與死亡組患者入院初始乳酸濃度、6小時(shí)早期乳酸清除率、早期乳酸面積、APACHEⅡ評(píng)分、SOFA評(píng)分之間存在統(tǒng)計(jì)學(xué)差異(P0.05)。2.Speraman相關(guān)分析的結(jié)果顯示:初始乳酸濃度與APACHEⅡ評(píng)分、SOFA評(píng)分呈正相關(guān)(r值分別為0.659、0.634,P值均0.05);早期乳酸面積與APACHEⅡ評(píng)分、SOFA評(píng)分呈正相關(guān)(r值分別為0.716、0.751,P值均0.05);6小時(shí)乳酸清除率與APACHEⅡ評(píng)分、SOFA評(píng)分呈負(fù)相關(guān)(r值分別為-0.726、-0.691,P值均0.05)。3.Logistic回歸分析結(jié)果顯示:入院初始乳酸濃度、6小時(shí)早期乳酸清除率、早期乳酸面積、APACHEⅡ評(píng)分、SOFA評(píng)分均為膿毒癥患者預(yù)后的生存危險(xiǎn)因素。上述指標(biāo)的ROC曲線(xiàn)下面積分別為0.727、0.766、0.936、0.829和0.817。結(jié)論:1.乳酸濃度及其動(dòng)態(tài)變化與膿毒癥患者的預(yù)后相關(guān)。2.入院初始乳酸濃度、6小時(shí)乳酸清除率、早期乳酸面積、APACHEⅡ評(píng)分和SOFA評(píng)分均可作為膿毒癥患者預(yù)后判斷的生存危險(xiǎn)因素,其中以早期乳酸面積為最優(yōu)。3.早期乳酸面積可作為預(yù)測(cè)成人膿毒癥患者預(yù)后的良好工具應(yīng)用于臨床。
[Abstract]:Objective: to conduct dynamic monitoring of arterial blood lactate level within 24 hours of admission of patients with sepsis, correlation analysis of early lactate area of patients with sepsis severity and prognosis of the disease and its clinical significance. Methods: a single center, prospective study method, study met the inclusion and exclusion criteria for adult sepsis patients with sepsis selected the First Affiliated Hospital of Henan University of Science and Technology from September 2015 to December 2016 in EICU were collected into groups of patients. The basic clinical data and dynamic monitoring of vital signs. All the patients were respectively on admission blood collection and blood routine examination, blood coagulation, liver and kidney function in laboratory. From the analysis and on the 6,12,18,24 hours arterial blood arterial blood gas at the time of admission. The record of arterial blood gas analysis results in the concentration of lactic acid and lactic acid according to the data collection time, The clearance rate calculation formula to calculate the 6 hour lactic acid clearance rate. The arterial blood lactate concentration time data in (x=, y= lactic acid concentration) markers in plane Cartesian coordinate system, the lines connecting the points, calculation formulas were calculated by 0-6h, 6-12h 12-18h, "trapezoid area, concentration time 18-24h the area under the above results were obtained for the early lactate area of each patients within 24 hours after admission in first. According to the difference of the record vital signs and indexes of patients admitted to hospital first days of APACHE II and SOFA score were calculated. All the patients were in accordance with the relevant guidelines for the treatment of sepsis the recommended treatment. Based on the survival situation during 28 days of follow-up, all patients were divided into survival group and death group. Comparison between the survival group and death group the basic clinical data, blood routine, liver and kidney function, the initial admission of lactic acid The concentration of 6 hours early lactate clearance rate, hospitalization first 24 hours early lactic acid area, APACHE score, SOFA score difference. The initial concentration of lactic acid were analyzed, 6 hour lactic acid clearance rate, early lactate area and APACHE score, SOFA score. The correlation between the application of Logistic regression analysis, including the admission of the concentration of lactic acid and lactic acid in early area, relevant factors and prognosis of APACHE score analysis. ROC curve of early lactate area, APACHE score to evaluate the prognosis of patients with sepsis correlation. Results: 120 patients were included, of which 66 were male, 54 were female. The results showed: 1. survival group and the death of patients the initial concentration of lactic acid, 6 hours early lactate clearance rate, early lactate area, APACHE score, there was significant difference between the score of SOFA (P0.05).2.Speraman correlation analysis showed that: The initial concentration of lactate and APACHE score, SOFA score was positively correlated (r = 0.659,0.634, P value was 0.05); the early lactate area and APACHE score, SOFA score was positively correlated (r = 0.716,0.751, P value was 0.05); 6 hour lactic acid clearance rate and APACHE score, SOFA score was negative correlation (r = -0.726, -0.691, P 0.05).3.Logistic regression analysis showed that the initial concentration of lactic acid in 6 hours of admission, early lactate clearance rate, early lactate area, APACHE score, SOFA score for the prognosis of patients with sepsis survival risk factors. The above indexes under ROC curve area 0.727,0.766,0.936,0.829 and 0.817. respectively. Conclusion: the changes of 1. lactic acid concentration and dynamic sepsis and prognosis of admission to the.2. initial concentration of lactic acid, 6 hour lactic acid clearance rate, early lactate area, APACHE score and SOFA score can be used as sepsis Survival risk factors for prognosis of patients, including early lactate area as the best.3., early lactate area, can be used as a good tool to predict the prognosis of adult sepsis.

【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R459.7

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