| Objective To observe guiding significance of blood lactate clearance rate to non-invasive positive pressure ventilation in the treatment of type Ⅰ respiratory failure patients. Methods All the observe subjects with type Ⅰ respiratory failure were selected from the admission patients of the respiratory ward of The First People’s Hospital of Lanzhou, who aged 24-87 yr and average( 72.17 ±12.93)yr.We measured the arterial blood lactate,Pa02,PCT and NT-pro BNP when admitted and 6h,24 h,48h,72 h,calculate6h,24 h blood lactate clearance.At the same time,monitoring of the observe subjects with clinical and laboratory indicators, including gender, age, breathing, blood pressure,body temperature, heart rate, liver and kidney function and so on. According to the outcome,they were divided into the survival group(73 cases) and the death group(7 cases),then the above data were compared. According to the level of blood lactic acid after 48 h,patients with arterial blood oxygen partial pressure is greater than 60 mm Hg can be divided into high blood lactic acid group(LAC≥2 Lmmol /) and low blood lactic acid group(LAC < 2 Lmmol /),the two groups of mortality were compared. Application SPSS17.0 software for data processing, the quantitative data using( x ± s) that the groups were compared using t test, count data using the X2 test. The correlation of two variables were analyzed, P<0.05 was considered statistically significant. Results Arterial blood lactate level when admitted and after 6h,24 h in non-survival group were higher than the survival group. Arterial blood lactate level on admission to hospital(8.16±3.12)Lmmol / VS(3.45 ±1.34) Lmmol /,6h arterial blood lactate level( 6.80 ±1.95)Lmmol / VS(2.96 ±1.13) Lmmol /.24 h arterial blood lactate level( 7.47±5.15)Lmmol / VS(2.48±0.60) Lmmol /;6h,24 h arterial blood lactate clearance were lower,6h arterial blood lactate clearance(0.11±0.21)%VS(0.22±0.09)%,24 h arterial blood lactate clearance(0.14±0.34)%VS(0.33 ±0.09)%.24 h arterial blood lactate clearance in the survival group was higher than 6h arterial blood lactate clearance:( 0.33±0.09)%VS(0.22±0.09)%.There is no difference between 24 h arterial blood lactate clearance in the non-survival group and 6h arterial blood lactate clearance:(0.14±0.34)%VS(0.11±0.21)%.According to the level of blood lactic acid after 48 h,patients with arterial blood oxygen partial pressure is greater than 60 mm Hg can be divided into high blood lactic acid group(24cases) and low blood lactic acid group(40cases).The two groups of mortality were 16.7%(4/24),2.5%(1/40) respectively,and the difference was significant(X2=4.180,P<0.05). The value showed a linear positive correlation between LAC and PCT and NT-pro BNP, a linear negative correlation between LAC and Pa02.Conclusion Blood lactate is a simple and effective index to assess patients severity, treatment effect and prognosis, and blood lactate clearance rate was more significant in the clinical.If blood lactate falls after given conventional treatment and mechanical ventilation treatment, the prognosis is good; If blood lactate doesn’t reduce, even if the arterial blood oxygen partial pressure returned to normal, there is a poor prognosis. Monitoring of blood lactate levels contributes to the assessment of the severity and the prognosis of non-invasive positive pressure ventilation in the treatment of type Ⅰ respiratory failure patients.And determination of blood lactate and blood gas analysis is simple and convenient, cost is low.As a result, it can be extensively applied in the hospital as an index of condition change.On the other hand, we can use these indicators, including blood lactic acid level, Pa02, NT- pro BNP, PCT,to timely judge patient’s condition changes and treatment curative effect, in order to timely adjust the treatment plan and prevent and treat the multiple organ dysfunction syndrome. |
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