The Meaning Of Blood Lactic Acid Dynamic Monitoring And Continuous Hemodynamic Monitoring Of Severe Case Trauma Patients

Objective: According to the early blood lactic acid, lactic acid clearance rate, hemodynamic change of severe case trauma patients, look for the relativity between the early blood lactic acid, lactic acid clearance rate and hemodynamic changes and survival rate of severe case trauma patients.Methods: Review and analyse 116 cases of severe case trauma patients which the EICU of ageneral hospital has admitted between 2008.Jan.01 and 2011.Feb.31. Group patients into Death Group (n=37) and Survival Group (n=79) according to the survival record the 14^th day after admitted. Group patients into 12^th hour lactic acid clearance rate≥10% (n=84) and 12^th hour lactic acid clearance rate < 10% (n=32) according to the difference of lactic acid clearance rate. Record arterial blood lactic acid, mean arterial pressure (MAP), cardiac index (CI), global end diastolic volume index (GEDI), systemic vascular resistance index (SVRI), pneumoangiogram vascular permeability index (PVPI) and extravascular lung water index (ELWI) of admitted and 72^nd hour admitted, lactic acid clearance rate of 6^th hour or 12^th hour [(Incipient lactic acid– 6^th hour or 12^th hour lactic acid) / incipient lactic acid * 100%] and the life status of 14^th day after admitted.Results:1.The lactic acid parameters of Death Group and Survival Group as being admitted are both higher than normal. However, there is no statistical difference. At the 6^th hour after admitted, the lactic acid parameters of the Death Group are obviously higher than the Survival Group. There is statistical significance in the difference (p < 0.05). After having fluid resuscitation, the blood lactic acid of both groups starts dropping. Relativity shows in lactic acid clearance rate and the global end diastolic volume index (GEDI) after fluid resuscitation. However, the lactic acid in death group is clearly higher than the survival group in each time spot after fluid resuscitation. The difference shows statistical significance (p < 0.05). There is obvious difference in the 6^th hour lactic acid clearance rate and 12^th hour lactic acid clearance rate of two groups. As admitted, the SVRI of two groups are obviously climbs. While fluid resuscitation is given, the global end diastolic volume index (GEDI) increases. Also, the lactic acid and SVRI clearly drop. Linear correlation is clearly showed between lactic acid and SVRI.2.There is no difference between the lactic acid of the 12^th hour lactic acid clearance rate≥10% group and the 12^th hour lactic acid clearance rate < 10% group. 6 hours after fluid resuscitation, lactic acid of two groups starts showing statistical difference. The lactic acid of 12^th hour lactic acid clearance rate≥10% group is clearly lower than the lactic acid of 12^th hour lactic acid clearance rate < 10% group. Statistical significance starts appearing between two groups of lactic acid parameters (p < 0.05). The death rate is only 13.09% in the 12^th hour lactic acid clearance rate≥10% group. The death rate of the 12^th hour lactic acid clearance rate < 10% group is up to 78.12%. There is clear difference between the death rates of two groups.Conclusion: Closely observe and monitor lactic acid level, calculate lactic acid clearance rate, hemodynamic change, Pulmonary Vascular Permeability Index (PVPI) and Extravascular Lung Water Index (ELWI) of severe case trauma patients. Giving reasonable fluid management under PICCO guideline is good for clear lactic acid and increase survival rate. The changes of lactic acid level and lactic acid clearance rate of severe case trauma patients could be used for evaluation severity of patient's condition and prognosis. While the 12^th hour lactic acid clearance rate is less than 10%, remind the patient that the prognosis may be worse. For severe case trauma patients, the monitoring of blood lactic acid and hemodynamic shall be taken as soon as possible. The understanding of hemodynamic characteristic, blood lactic acid level and lactic acid clearance rate of patients in the early time after being admitted, contributes to direct therapy, improve hypoxia status, increase patient's survival rate.