The Relationship between Arterial and Venous Blood Lactic Acid in Early Stage of Septic Shock and Prognostic Value of Lactate and Lactate Clearance Rate
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摘要:
目的 分析脓毒性休克患者的动脉、中心静脉及外周静脉血乳酸浓度的相关性，探讨不同时间段血乳酸、乳酸清除率对脓毒性休克患者预后的评估价值。 方法 选择昆明医科大学第一附属医院3号楼ICU 2020年6月至2021年2月期间收治的60例脓毒性休克患者为研究对象，收集入组患者一般资料，监测入住ICU时及治疗后6 h、12 h、24 h动脉、外周静脉、中心静脉血血气参数，以及48 h、72 h动脉血血气参数。首先根据血样本的来源分为动脉、中心静脉、外周静脉组，分析3组之间血乳酸浓度的相关性，然后根据患者28 d存活情况分为死亡组和存活组，探讨早期不同时间段血乳酸、乳酸清除率对病情预后的评估价值。 结果 （1）经Pearson相关性分析，入住ICU时及治疗后6 h、12 h、24 h动脉与中心静脉乳酸值具有相关性，各时间段r值在0.89～0.90之间，P < 0.05；入住ICU时及治疗后6 h、12 h、24 h动脉与外周静脉乳酸值具有相关性，各时间段r值在0.83～0.87之间，P < 0.05；（2）经绘制ROC曲线，初始及治疗后6 h、12 h、24 h、48 h、72 h动脉乳酸AUC分别为0.64，0.62，0.64，0.72，0.66，0.63，P < 0.05，动脉24 h乳酸AUC最大，其最佳截断值 = 2.42 mmol/L，灵敏度 = 0.64，特异度 = 0.66；（3）经绘制ROC曲线，6 h、12 h、24 h、48 h、72 h动脉乳酸清除率AUC分别为0.66，0.61，0.74，0.72，0.70，P < 0.05，24 h乳酸清除率AUC最大，其最佳截断值 = 19.57%，灵敏度 = 0.64，特异度 = 0.68。 结论 （1）脓毒性休克患者早期动脉与中心静脉、外周静脉血乳酸水平具有相关性；（2）治疗后24 h的动脉血乳酸及乳酸清除率对脓毒性休克患者预后具有较好的评估价值。 Abstract: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. -
Key words:
- Septic shock /
- Blood lactate /
- Lactate clearance rate /
- Prognosis evaluation
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图 1 动脉与中心静脉、外周静脉乳酸散点图
①：动脉与中心静脉初始乳酸散点图；②：动脉与外周静脉初始乳酸散点图；③：动脉与中心静脉6 h乳酸散点图；④：动脉与外周静脉6 h乳酸散点图；⑤：动脉与中心静脉12 h乳酸散点图；⑥：动脉与外周静脉12 h乳酸散点图；⑦：动脉与中心静脉24 h乳酸散点图；⑧：动脉与外周静脉24 h乳酸散点图。
Figure 1. scatter plot of lactic acid in artery，central vein and peripheral vein
图 2 动脉乳酸对患者预后的ROC曲线分析
Figure 2. ROC curve analysis of arterial lactic acid for patient outcome
图 3 乳酸清除率对患者预后的ROC曲线分析
Figure 3. ROC curve analysis of lactate clearance on patient outcomes
表 1 基本情况比较[
$ \bar x \pm s $ /n（%）]Table 1. The comparison of basic data [
$ \bar x \pm s $ /n（%）]指标 存活组（n = 25） 死亡组（n = 35） χ2/t P 性别 0.019 0.891 男 16 23 女 9 12 年龄（岁） 63.20 ± 11.98 74.11 ± 14.95 −3.021 0.004* 感染部位（n） 4.402 0.221 腹腔 10 6 肺部 11 22 皮肤软组织 2 5 其他 2 2 APACHE Ⅱ评分 21.08 ± 6.54 25.54 ± 6.54 −2.606 0.012* SOFA评分 10.24 ± 2.49 12.06 ± 2.92 −2.524 0.014* *P < 0.05。 
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表 2 动脉与中心静脉、外周静脉乳酸相关性分析[（
$ \bar x \pm s $ ），mmol/L]Table 2. Correlation analysis between arterial，central vein and peripheral vein lactic acid [（
$ \bar x \pm s $ ），mmol/L]指标 $ \bar x \pm s $ r P 初始中心静脉乳酸 4.12 ± 2.42 0.90 < 0.001* 初始外周静脉乳酸 4.34 ± 1.87 0.85 < 0.001* 6 h中心静脉乳酸 4.21 ± 1.63 0.89 < 0.001* 6 h外周静脉乳酸 4.42 ± 1.72 0.83 < 0.001* 12 h中心静脉乳酸 3.52 ± 1.92 0.89 < 0.001* 12 h外周静脉乳酸 3.72 ± 1.02 0.86 < 0.001* 24 h中心静脉乳酸 4.03 ± 1.02 0.90 < 0.001* 24 h外周静脉乳酸 4.31 ± 1.63 0.87 < 0.001* *P < 0.05。
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表 3 2组患者动脉血乳酸比较[（
$ \bar x \pm s $ ），mmol/L]Table 3. Comparison of arterial blood lactic acid between 2 groups [（
$ \bar x \pm s $ ），mmol/L]分组 治疗开始时 6 h 12 h 24 h 48 h 72 h F P 存活组 3.60 ± 2.33 3.26 ± 2.40 2.92 ± 1.69 2.45 ± 1.68 2.41 ± 1.92 2.41 ± 1.66 17.217 < 0.001* 死亡组 4.53 ± 2.79 5.04 ± 3.01 4.88 ± 2.92 5.97 ± 3.89 6.21 ± 4.02 6.55 ± 4.62 *P < 0.05。
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表 4 2组患者乳酸清除率比较（
$ \bar x \pm s $ ）Table 4. Comparison of lactic acid clearance rate between 2 groups （
$ \bar x \pm s $ ）分组 6 h 12 h 24 h 48 h 72 h F P 存活组 8.28 ± 4.26 7.22 ± 2.18 22.11 ± 4.88 71.26 ± 40.40 82.61 ± 53.56 10.373 0.002* 死亡组 −20.40 ± 8.22 −18.27 ± 8.81 −54.17 ± 9.72 −9.06 ± 6.22 −3.35 ± 1.54 *P < 0.05。
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