摘要目的 探讨早期联合检测动脉血乳酸与剩余碱(BE)对脓毒症患者预后的评估价值.方法 回顾性分析2009年7月至2012年12月入住本院重症监护病房(ICU)脓毒症患者的临床资料,按照预后分为存活组和死亡组,比较两组患者入院时动脉血乳酸及BE的差异,观察动脉血乳酸、BE及两者联合判断预后的受试者工作特征曲线(ROC曲线)下面积(AUC),并寻找出动脉血乳酸及BE预测脓毒症预后的最佳截断值.结果 共纳入118例脓毒症患者,其中存活组75例,死亡组43例.存活组和死亡组入院动脉血乳酸[mmol/L:1.20(0.90)和2.30(1.90)]及BE(mmol/L:0.44±5.13和-4.35±4.86)比较差异均有统计学意义(均P=0.000).动脉血乳酸、BE及两者联合预测脓毒症的AUC分别为0.805、0.755及0.822.在动脉血乳酸＞1.7 mmol/L及BE＜-3 mmol/L时,具有较高的敏感度(79.1％和69.8％)及阳性似然比(3.955和2.493).结论 入院时动脉血乳酸联合BE检测可以较好地预测脓毒症患者的预后.

abstractsObjective To study the prognostic value of arterial lactate combined with base excess (BE) in sepsis patients.Methods Clinical data of patients admitted to intensive care unit (ICU) from July 2009 to December 2012 were retrospectively analyzed.Patients were divided into survivor group and non-survivor group,and the arterial blood lactate and BE concentrations were compared between groups.The receiver operating characteristic curve (ROC curve) was drawn and area under the ROC curve (AUC) was calculated to analyze the function of arterial lactate,BE and their combination in judging the prognosis of sepsis.The best cut-off values of arterial lactate and BE for sepsis prognosis were searched.Results One hundred and eighteen patients were enrolled with 75 in survivor group and 43 in non-survivor group.There were significant differences in arterial lactate [mmol/L:1.20 (0.90),2.30 (1.90)] and BE (mmol/L:0.44 ± 5.13,-4.35 ± 4.86) between two groups (both P=0.000).The AUC for mortality prediction was 0.805,0.755 and 0.822 for arterial blood lactate,BE,and their combination respectively.Using arterial lactate higher than 1.7 mmol/L and BE lower than-3 mmol/L as cut-off values,a better sensitivity (79.1％ and 69.8％) and positive predictive value (3.955 and 2.493) can be obtained.Conclusion Combination of arterial lactate and BE can be a better indicator of prognosis in sepsis patients.