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目的：探讨血清降钙素原（procalcitonin，PCT）、乳酸清除率及危重疾病评分（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHEⅡ）对脓毒症预后的评估价值。方法：选择2011 年2 月~2013 年2 月期间我院收治的脓毒症休克及严重脓毒症患者 92例，其中脓毒症休克37 例，严重脓毒症者55 例；存活60 例，死亡32 例。对本组患者血清PCT、乳酸清除率及APACHEⅡ进行分析，探讨以上指标对其预后的评定价值。结果：①死亡组血清PCT、APACHEⅡ、乳酸分值均大于存活组，左心射血分数（Left ventricular ejection fraction，LVEF）及早期乳酸清除率小于存活组，对比具有统计学意义（P<0.01 或P<0.05）；② 脓毒性休克组血清 PCT、APACHEⅡ、乳酸分值均大于严重脓毒症组，LVEF 及早期乳酸清除率小于严重脓毒症组，对比具有统计学意义（P<0.01 或 P<0.05）；③本组乳酸与APACHEⅡ呈正相关性（P<0.01），早期乳酸清除率与APACHEⅡ呈负相关性（P<0.01）。结论：PCT、乳酸清除率及APACHEⅡ评分可以作为脓毒血症预后的有效评估指标，通过对PCT、乳酸清除率及APACHEⅡ评分监测以便尽早采取积极的治疗措施，改善预后情况。

英文摘要:

Objective:To explore the significance of serumprocalcitonin (PCT), lactate clearance rate and Acute Physiology and Chronic Health Evaluation Ⅱ ( APACHE Ⅱ) in the evaluation of sepsis.Methods:92 patients with septic shock and severe sepsis were selected in our hospital fromFebruary 2012 to February 2013, including37 cases of septic shock and 55 cases of severe sepsis patients; 60 cases survived, 32 cases died. The serum levels of PCT, lactate clearance rate and APACHE Ⅱ analysis, discussion of the assessment value of above indexes on the prognosis.Results:① The serum levels of PCT, APACHE Ⅱ , lactate values of death group were greater than the survival group, LVEF and the early lactate clearance rate is less than the survival group (P<0.01 or P<0.05); ② Septic shock group serumPCT, APACHE Ⅱ scores, lactic acid more severe sepsis group, LVEF and early lactate clearance rate less than severe sepsis group (P<0.01 or P<0.05); ③ The lactic acid and APACHE Ⅱ were positively correlated (P<0.01), the early lactate clearance rate was negatively correlated with APACHE II (P <0.01).Conclusion:PCT, lactate clearance rate and APACHE Ⅱ can be used as an effective evaluation index of sepsis prognosis, through the PCT, lactic acid clearance rate and APACHE Ⅱ monitoring so as to take active treatment, improve the prognosis of the patients.

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