【摘要】 目的探讨动态监测血乳酸（LAC）在多脏器功能障碍综合征（MODS）患者治疗中的指导意义。方法选择2015年1月²016年10月在兰州市第一人民医院重症医学科收治的63例MODS患者,根据监测LAC与否分成实验组和对照组。实验组32例,根据LAC水平、中心静脉压（CVP）、中心静脉血氧饱和度（Scv O₂）、平均动脉压（MAP）及尿量这5个变量调整补液、血管活性药物及升级治疗;对照组31例,根据监测CVP、Scv O₂、MAP及尿量这4个变量调整补液、血管活性药物及升级治疗。记录两组患者入院时、入院24 h、48 h、72 h的Glasgow昏迷评分（GCS）、氧合指数（PaO₂/Fi O₂）、压力调整心率（PAHR）、胆红素、Cr、PLT,并在各个时间段将这些指标进行MODS严重程度评分,比较两组患者入院时及治疗72 h后WBC、PCT及APACHEⅡ,比较两组患者不同时间点的MODS严重程度评分、使用机械通气时间、住重症医学科的时间及死亡率。结果治疗72 h,实验组WBC、PCT明显低于对照组,差异有统计学意义（P<0.01）;实验组APACHEⅡ、MODS评分明显低于对照组,差异有统计学意义（P<0.01）;实验组使用机械通气时间、住ICU时间明显短于对照组（P<0.01）。结论动态监测LAC和乳酸清除率（LCR）对MODS患者的治疗具有重要的指导意义,该指标稳定、可靠、可缩短使用机械通气的时间及住重症医学科的时间。更多还原

【Abstract】 Objective To investigate the significance of dynamic monitoring of blood lactic acid（LAC） in the treatment of multiple organ dysfunction syndrome（MODS）.Methods 63 patients with MODS in the Intensive Care Unit of the First People′ s Hospital of Lanzhou City treated from January 2015 to October 2016 were divided into experimental group and control group according to the monitoring of LAC or not.The supplementary liquid and vasoactive drugs were adjusted and the treatment was upgraded according to blood LAC level,CVP,Scv O₂,MAP and urine volume on 32 cases in experimental group,but according to CVP,Scv O₂,MAP and urine volume on 31 cases in control group only.The GCS,PaO₂/Fi O₂,PAHR,bilirubin,Cr,PLT of two groups were recorded and scored for MODS severity on admission,24 hours,48 hours and 72 hours after admission.WBC,PCT and APACHE Ⅱwere compared between two groups were on admission and 72 hours after admission.And MODS severity score,mechanical ventilation time,duration in intensive care unit and mortality were compared.Results WBC,PCT of the experimental group was significantly lower than that of the control group 72 hours after admission,and the difference was statistically significant（P<0.01）;APACHE,MODS score of the experimental group was significantly lower than that of the control group,and the difference was statistically significant（P<0.01）;mechanical ventilation time,duration in intensive care unit of the experimental group was significantly shorter than that of the control group,and the difference was statistically significant（P<0.01）.Conclusion Dynamic monitoring of LAC and lactate clearance rate（LCR） has important guiding significance in the treatment of MODS,the index is stable,reliable and can shorten mechanical ventilation time and duration in intensive care unit.更多还原