血乳酸动态监测对评估动脉瘤性蛛网膜下腔出血预后的价值

Dynamic blood lactate monitoring and its prognostic value in patients with aneurysmal subarachnoid hemorrhage

摘要:

目的 探讨血乳酸动态监测对评估动脉瘤性蛛网膜下腔出血患者预后的价值。方法 收集2015年9月至2016年9月收治的86例动脉瘤性蛛网膜下腔出血患者，依照格拉斯哥预后评分分为预后良好组58例和不良组28例；回顾性分析入院即刻、术后即刻、术后第1天、第3天及第5天血乳酸值，比较组间的差异。结果 预后良好组患者入院即刻、术后即刻、术后第1天及第3天血乳酸值均显著低于预后不良组（1.97±1.42、1.24±0.86、1.36±0.90、1.14±0.50 vs.3.20±1.54、1.98±1.11、2.28±1.58、1.73±1.23，P<0.05）；Hunt-Hess分级Ⅳ~Ⅴ级组入院即刻、术后即刻、术后第1天及术后第3天血乳酸值均显著高于Ⅰ~Ⅲ级组（P<0.05）；通过二分类logistic回归分析，发现术后第3天血乳酸值是患者不良预后的独立危险因素（OR=3.184，95% CI：1.065~9.507，p=0.038）。结论 动脉瘤性蛛网膜下腔出血患者急性期内血乳酸的动态监测对于评估病情及预后有重要价值；术后第三天血乳酸水平是不良预后的独立危险因素。

Abstract:

Objective To investigate the prognostic value of dynamic blood lactate monitoring in patients with aneurysmal subarachnoid hemorrhage (aSAH).Methods We retrospectively reviewed 86 patients with aSAH who were admitted to our hospital from September 2015 to September 2016. These subjects were divided into favorable outcome group (58 cases) and unfavorable outcome group (28 cases) according to the Glasgow Outcome Scale score. The two groups were compared in terms of serum lactate on admission and at 0, 1, 3, and 5 days after microsurgery.Results The favorable outcome group had significantly lower serum lactate levels than the unfavorable outcome group on admission and at 0, 1, and 3 days after microsurgery (1.97±1.42/1.24±0.86/1.36±0.90/1.14±0.50 vs 3.20±1.54/1.98±1.11/2.28±1.58/1.73±1.23, P<0.05). The Hunt-Hess grade IV-V patients had significantly higher serum lactate levels than the Hunt-Hess grade I-Ⅲ patients on admission and at 0, 1, and 3 days after microsurgery (P<0.05). Binary logistic regression analysis showed that Hunt-Hess grade, Fisher grade, and serum lactate level at 3 days after microsurgery were prognostic factors (odds ratio=3.184, 95%CI:1.065-9.507, P=0.038).Conclusions In the acute stage of aSAH, dynamic blood lactate monitoring has great value in assessing disease condition and outcome; the blood lactate level at 3 days after microsurgery is an independent prognostic factor.