Value of blood lactate combined with APACHE Ⅱ score in the prediction of the prognosis of acute exacerbation of chronic obstructive pulmonary disease with respiratory failure
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 32, Issue 9, Pages: 795-799(2023)
- 作者机构：
徐州市中心医院呼吸与危重症医学科，江苏 徐州 221006
- 作者简介：
- 基金信息：
DOI：10.11659/jjssx.11E022003
CLC： R563Published：25 September 2023，
Received：01 November 2022，
扫 描 看 全 文
黄振,刘乃嘉.血乳酸联合APACHE Ⅱ评分预测慢性阻塞性肺疾病急性加重期并呼吸衰竭预后的价值[J].局解手术学杂志,2023,32(09):795-799.
HUANG Zhen,LIU Nai-jia.Value of blood lactate combined with APACHE Ⅱ score in the prediction of the prognosis of acute exacerbation of chronic obstructive pulmonary disease with respiratory failure[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(09):795-799.
黄振,刘乃嘉.血乳酸联合APACHE Ⅱ评分预测慢性阻塞性肺疾病急性加重期并呼吸衰竭预后的价值[J].局解手术学杂志,2023,32(09):795-799. DOI： 10.11659/jjssx.11E022003.
HUANG Zhen,LIU Nai-jia.Value of blood lactate combined with APACHE Ⅱ score in the prediction of the prognosis of acute exacerbation of chronic obstructive pulmonary disease with respiratory failure[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(09):795-799. DOI： 10.11659/jjssx.11E022003.
摘要
目的
2
探讨血乳酸联合急性生理与慢性健康Ⅱ（APACHE Ⅱ）评分对慢性阻塞性肺疾病急性加重期（AECOPD）并呼吸衰竭患者预后的预测价值。
方法
2
选取本院2020年2月至2022年1月收治的156例AECOPD并呼吸衰竭患者，根据预后情况分为预后不良组与预后良好组。对比2组患者入院时、入院12 h、入院24 h血乳酸水平及APACHE Ⅱ评分，分析预后不良的影响因素及血乳酸联合APACHE Ⅱ评分对预后不良的预测价值。
结果
2
AECOPD并呼吸衰竭患者预后不良发生率为28.85%；入院时、入院12 h、入院24 h预后不良组血乳酸水平及APACHE Ⅱ评分均先升高后降低（
P
<
0.05），预后良好组则逐渐降低（
P
<
0.05），且预后不良组入院时、入院12 h、24 h血乳酸水平及APACHE Ⅱ评分均高于预后良好组（
P
<
0.05）。高血糖，机械通气时间较长，入院12 h、入院24 h血乳酸水平及APACHE Ⅱ评分较高均是预后不良的危险因素（
P
<
0.05）。入院12 h、入院24 h血乳酸水平与APACHE Ⅱ评分联合预测AECOPD并呼吸衰竭患者预后不良的灵敏度、曲线下面积（
AUC
）均高于单独预测（
P
<
0.05），特异度与单独预测比较差异无统计学意义（
P
>
0.05），且入院24 h血乳酸水平、APACHE Ⅱ评分联合预测的
AUC
高于入院12 h（
P<
0.05）。
结论
2
AECOPD并呼吸衰竭患者入院12 h、入院24 h血乳酸水平和APACHE Ⅱ评分与预后不良密切相关，且入院24 h血乳酸联合APACHE Ⅱ评分对预后的预测价值更高。
Abstract
Objective
2
To investigate the prognostic value of blood lactate combined with acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and respiratory failure.
Methods
2
A total of 156 patients with AECOPD with respiratory failure treated in our hospital from February 2020 to January 2022 were selected，and they were divided into the poor prognosis group and good prognosis group according to their prognosis.The blood lactate levels and APACHE Ⅱ scores at admission， 12 hours after admission and 24 hours after admission of the two groups were compared.The influencing factors of poor prognosis and the predictive value of blood lactate combined with APACHE Ⅱ score for poor prognosis were analyzed.
Results
2
The incidence of poor prognosis in patients with AECOPD and respiratory failure was 28.85%.The blood lactate levels and APACHE Ⅱ scores at admission， 12 hours after admission and 24 hours after admission in the poor prognosis group were first increased and then decreased （
P
<
0.05），and those in the good prognosis group were gradually decreased （
P
<
0.05）， and the blood lactate levels and APACHE Ⅱ scores at admission， 12 hours after admission and 24 hours after admission in the poor prognosis group were higher than those in the good prognosis group （
P
<
0.05）.Hyperglycemia，long mechanical ventilation time，and high levels of blood lactate and APACHE Ⅱ scores 12 hours after admission and 24 hours after admission were the risk factors of poor prognosis （
P
<
0.05）.The sensitivity and
area under the curve
（
AUC
） of blood lactate levels combined with APACHE Ⅱ scores 12 hours and 24 hours after admission in predicting the poor prognosis of AECOPD patients with respiratory failure were higher than those of individual prediction （
P
<
0.05），but there was no significant differences in the specificity between the combined prediction and individual prediction （
P>
0.05），and the
AUC
of the combined prediction of blood lactate level and APACHE Ⅱ score 24 hours after admission was higher than that of 12 hours after admission （
P
>
0.05）.
Conclusion
2
The blood lactate levels and APACHE Ⅱ scores of AECOPD patients with respiratory failure 12 hours and 24 hours after admission are closely related to the poor prognosis，and the prediction value of blood lactate combined with APACHE Ⅱ score 24 hours after admission is higher.
关键词
血乳酸急性生理与慢性健康评分Ⅱ慢性阻塞性肺疾病急性加重期呼吸衰竭
Keywords
blood lactateacute physiology and chronic health evaluation Ⅱacute exacerbation of chronic obstructive pulmonary diseaserespiratory failure
references
Ritchie AI，Wedzicha JA.Definition，causes，pathogenesis，and consequences of chronic obstructive pulmonary disease exacerbations［J］.Clin Chest Med，2020，41（3）：421-438.doi：10.1016/j.ccm.2020.06.007http://dx.doi.org/10.1016/j.ccm.2020.06.007.
Ruvuna L，Sood A.Epidemiology of chronic obstructive pulmonary disease［J］.Clin Chest Med，2020，41（3）：315-327.doi：10.1016/j.ccm.2020.05.002http://dx.doi.org/10.1016/j.ccm.2020.05.002.
Martí JD，McWilliams D，Gimeno-Santos E.Physical therapy and rehabilitation in chronic obstructive pulmonary disease patients admitted to the intensive care unit［J］.Semin Respir Crit Care Med，2020，41（6）：886-898.doi：10.1055/s-0040-1709139http://dx.doi.org/10.1055/s-0040-1709139.
徐亚莉，王玮，杨琦，等.老年慢性阻塞性肺疾病急性加重期病人乳酸、PaCO2动态变化规律与预后的关系研究［J］.实用老年医学，2020，34（3）：299-300.doi：10.3969/j.issn.1003-9198.2020.03.023http://dx.doi.org/10.3969/j.issn.1003-9198.2020.03.023.
陈菊梅，王微，邱婉容，等.APACHEⅡ评分在慢性阻塞性肺疾病急性加重患者无创通气治疗时机选择中的应用研究［J］.中华危重病急救医学，2020，32（5）：581-584.doi：10.3760/cma.j.cn121430-20200106-00159http://dx.doi.org/10.3760/cma.j.cn121430-20200106-00159.
Yin J，Wang S，Qiu Y，et al.Screening for and combining serum intestinal barrier-related biomarkers to predict the disease severity of AECOPD［J］.Ann Palliat Med，2021，10（2）：1548-1559.doi：10.21037/apm-20-1060http://dx.doi.org/10.21037/apm-20-1060.
中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南（2021年修订版）［J］.中华结核和呼吸杂志，2021，44（3）：170-205.doi：10.3760/cma.j.cn112147-20210109-00031http://dx.doi.org/10.3760/cma.j.cn112147-20210109-00031.
Orr JE，Azofra AS，Tobias LA.Management of chronic respiratory failure in chronic obstructive pulmonary disease：high-intensity and low-intensity ventilation［J］.Sleep Med Clin，2020，15（4）：497-509.doi：10.1016/j.jsmc.2020.08.007http://dx.doi.org/10.1016/j.jsmc.2020.08.007.
于海容，张柳，权帅，等.肺泡动脉氧分压差与血乳酸水平在AECOPD合并呼吸衰竭患者预后评估中的临床意义［J］.国际呼吸杂志，2021，41（13）：998-1002.doi：10.3760/cma.j.cn131368-20200613-00501http://dx.doi.org/10.3760/cma.j.cn131368-20200613-00501.
胡承志，陈春燕，徐俊，等.慢性阻塞性肺疾病急性加重期患者血乳酸动态变化及其与病情分级、预后的相关性分析［J］.中国临床医生杂志，2020，48（12）：1420-1423.doi：10.3969/j.issn.2095-8552.2020.12.011http://dx.doi.org/10.3969/j.issn.2095-8552.2020.12.011.
Glancy B，Kane DA，Kavazis AN，et al.Mitochondrial lactate metabolism：history and implications for exercise and disease［J］.J Physiol，2021，599（3）：863-888.doi：10.1113/JP278930http://dx.doi.org/10.1113/JP278930.
Zhang XM，Zhang WW，Yu XZ，et al.Comparing the performance of SOFA，TPA combined with SOFA and APACHE-Ⅱ for predicting ICU mortality in critically ill surgical patients：asecondary analysis［J］.Clin Nutr，2020，39（9）：2902-2909.doi：10.1016/j.clnu. 2019.12.026http://dx.doi.org/10.1016/j.clnu.2019.12.026.
李嘉.老年慢性阻塞性肺疾病急性加重期并呼吸衰竭患者机械通气脱机失败的多因素分析［J］.中国临床医生杂志，2020，48（1）：57-60.doi：10.3969/j.issn.2095-8552.2020.01.016http://dx.doi.org/10.3969/j.issn.2095-8552.2020.01.016.
陈龙，张丹嗣，刘丹舟.经鼻高流量湿化氧疗对慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者血气分析指标及平均动脉压的影响［J］.临床和实验医学杂志，2020，19（21）：2295-2299.doi：10.3969/j.issn.1671-4695.2020.21.016http://dx.doi.org/10.3969/j.issn.1671-4695.2020.21.016.
Upadhyay J，Trivedi N，Lal A.Risk of future type 2 diabetes mellitus in patients developing steroid-induced hyperglycemia during hospitalization for chronic obstructive pulmonary disease exacerbation ［J］.Lung，2020，198（3）：525-533.doi：10.1007/s00408-020-00356-zhttp://dx.doi.org/10.1007/s00408-020-00356-z.
Duiverman ML，Vonk JM，Bladder G，et al.Home initiation of chronic non-invasive ventilation in COPD patients with chronic hypercapnic respiratory failure：a randomised controlled trial［J］.Thorax，2020，75（3）：244-252.doi：10.1136/thoraxjnl-2019-213303http://dx.doi.org/10.1136/thoraxjnl-2019-213303.
0
Views
1
下载量
0
CSCD
- L-PDFDownload
- WORDDownload
- Meta-XMLDownload
- BibTeXDownload
- EndnoteDownload
- RefMan Download
- NoteExpressDownload
- NoteFirstDownload
Publicity Resources
Related Articles
Related Author
Related Institution
- Technical support is provided by Beijing Founder electronics co., LTD 京ICP备09064830号-19
京公网安备11010802024621 - It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
- Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.
