Objective To explore the value of blood lactic acid and its 6 h lactic clearance in the prognostic evaluation of severe patients. Methods 58 cases were chosen in critically ill patients, their arterial blood lactic acidlevel was tested on admission, and re-tested 6 h after treatment. The 6h blood lactic clearance and corresponding A-PACHE Ⅱ score were calculated. According to the morbid outcome, patients were divided into the survival group ( n = 43) and the death group (n = 15). According to the patients'blood lactic acid concentration on admission, patients were divided into hyperlactacidemia group ( n = 38 ) and lactic acidosis group ( n = 20 ) . According to the 6h blood lactic clearance, patients were divided into low 6h lactic clearance group ( n = 23 ) and high 6 h lactic clearance group ( re = 35). Results Compared with the death group, the 6h blood lactic clearance of the patients in the survival group was higher (P ＜0. 01) ,and there was no significant difference in the blood lactic acid and APACHE Ⅱ score between two groups on admission (P ＞0. 05). The APACHE Ⅱ scores and fatality rate of patients in hyperlactacidemia group were lower than those in lactic acidosis group (P ＜ 0. 05 ). The mortality rate in the low 6 h lactic clearance group was higher than the high 6 h lactic clearance group ( P ＜ 0. 05 ) , while the APACHE Ⅱ score of patients in two groups had no significant difference. In severe patients,the APACHE Ⅱ score was along with the blood lactic acid level increasing gradually (P ＜0. 05). Conclusion Blood lactic acid level could be used as the index to judge the severity degree of severe patients,and 6h lactic clearance should have more significance for prognosis evaluation.%目的 探讨重症患者的血乳酸水平及其6h清除率在预后评估中的价值.方法 选择58例重症患者,入ICU时检测其动脉血乳酸水平,并在6h后复检,计算出该患者6h血乳酸清除率及相应的A-PACHEⅡ评分；根据疾病的转归,将患者分为存活组(43例)和死亡组(15例)；按患者入ICU时的血乳酸浓度,将患者分为高乳酸血症组(38例)和乳酸性酸中毒组(20例)；根据6h血乳酸清除率值,将患者分为低乳酸清除率组(23例)和高乳酸清除率组(35例).结果 与死亡组相比,存活组患者的6h血乳酸清除率高[ (38.74±2.24)％ vs.(16.28±2.31)％,P＜0.01],而入ICU时的血乳酸水平和APACHEⅡ评分两组间差异无统计学意义(P＞0.05)；高乳酸血症组患者病死率和APACHEⅡ评分均低于乳酸性酸中毒组(P＜0.05)；低6h血乳酸清除率组患者病死率高于高6h乳酸清除率组(43.43％vs.14.28％,P＜0.05),两组间APACHEⅡ评分差异无统计学意义；重症患者随着血乳酸水平增加APACHEⅡ评分也逐渐升高(P＜0.05).结论 血乳酸水平可作为判断重症患者病情严重程度的指标,而6h血乳酸清除率对患者的预后评估意义更大.
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