脓毒性休克患者早期动、静脉血乳酸相关性及乳酸、 乳酸清除率的预后评估价值.

Objectives To analyze the correlation of blood lactate concentration in artery，central vein and peripheral vein of patients with septic shock，and to explore the value of blood lactate and lactate clearance rate in different periods of time in evaluating the prognosis of patients with septic shock. Methods A total of 60 patients with septic shock in ICU of building 3 of the First Affiliated Hospital of Kunming Medical University from June 2020 to February 2021 were selected as the research objects. The general data of the patients were collected，and the blood gas parameters of artery，peripheral vein and central vein at admission and 6 h，12 h and 24 h after treatment， as well as arterial blood gas parameters at 48 h and 72 h after the treatment were monitored. First，according to the source of blood samples，they were divided into the artery group，the central vein group and the peripheral vein group. The correlation of blood lactic acid concentration in artery，central vein and peripheral vein was analyzed. Then，according to the 28 day survival of patients，they were divided into the death group and the survival group. The evaluation value of blood lactic acid and lactic acid clearance rate in different periods of early stage on the prognosis of patients was discussed. Results （1） According to Pearson correlation analysis，there was a correlation between arterial lactic acid and central venous lactic acid at ICU admission and 6 h，12 h，24 h after the treatment，with r value between 0.89-0.90 at each time period，P < 0.05；there was a correlation between arterial lactic acid and peripheral venous lactic acid at ICU admission and 6 h，12 h，24 h after treatment，with r value between 0.83-0.87 at each time period，P < 0.05. （2） By drawing ROC curve，the AUC of arterial lactic acid at the initial and 6 h，12 h，24 h，48 h and 72 h after the treatment were 0.64，0.62，0.64，0.72，0.66，0.63， respectively， P < 0.05. The AUC of arterial lactate was the highest at 24 h，with the best cutoff value of 2.42 mmol/L，sensitivity of 0.64 and specificity of 0.66. （3） By drawing the ROC curve，the AUC of arterial lactic acid clearance at 6 h，12 h，24 h，48 h and 72 h were 0.66，0.61，0.74，0.72 and 0.70，respectively， P < 0.05. The AUC of 24 h lactate clearance was the highest，with the best cutoff value of 19.57%，sensitivity of 0.64 and specificity of 0.68. Conclusions （1） There is a correlation between arterial and central venous blood lactic acid levels and between arterial and peripheral venous blood lactic acid levels in patients with septic shock. （2） The arterial lactate and lactate clearance rate 24 hours after the treatment have a good evaluation value for the prognosis of patients with septic shock. [ABSTRACT FROM AUTHOR]