关键词: 休克指数, 血气乳酸水平, 预测, 院前, 创伤性休克

Abstract: Objective To explore and compare the application of shock index（SI）and blood lactic acid level in predicting the prognosis of patients with pre-hospital traumatic shock. Methods From December 2020 to December 2023,80 patients with traumatic shock were enrolled,and their SI and levels of lactic acid were monitored．Patients were grouped according to the monitoring results：normal group：lactic acid level below 2 mmol/L,increased group：above 2 mmol/L;normal group：SI below 0.9,and increased group：SI above 0.9．The sequential organ failure score（SOFA）was observed and recorded 7 days after hospitalization,and the situation of multiple organ dysfunction syndrome（MODS）was evaluated．At the same time,mechanical ventilation,the use of vasoactive substances and hospitalization were observed and recorded．Results There were 60 cases in the group with increased lactic acid level and 20 cases in the normal group．There were 58 cases of increased SI and 22 cases of normal．The lactic acid level and SI index in women were higher than those in men,with no difference（P>0.05）．There were no differences in age,sex,SI index and the incidence of MODS（P>0.05）．GCS score（4.22±1.53 vs 9.46±3.82）,hospitalization days（23.34±5.71 vs 12.26±2.11）d,basal lactate value（4.75±2.36 vs 2.04±1.11）mmol L-1 were significantly different from those of MODS（t=11.830,P<0.001;t=6.721,P<0.001,P<0.05）．There were 27 cases with volume resuscitation systolic blood pressure > 80 mmhg（%）in the group with increased SI,which was different from that of SI and lactic acid（46.55% vs 18.18%,χ²=12.237,P<0.001;P<0.05）．Lactic acid increased group：11 patients received mechanical ventilation,and the lactic acid levels of all 11 patients increased（P<0.05）．Nine patients used vasoactive substances,and their lactic acid levels all increased,with no significant difference（P>0.05）．Of the 38 inpatients,24 cases had elevated lactic acid levels（P<0.05）．Thirteen patients received mechanical ventilation,and 12 patients had elevated SI,with no statistical significance（P>0.05）．Eleven patients were treated with vasoactive agents,and 8 patients had increased SI,with no difference（P>0.05）．Among the 39 patients hospitalized,22 cases had increased SI,and the difference was statistically significant（P<0.05）．Conclusions For patients with severe traumatic shock,when the blood lactic acid level increases,the probability of MODS will be greatly increased．Compared with SI index,lactic acid level has higher application value in predicting the prognosis of patients with severe traumatic shock．

Key words: shock index, blood gas lactate level, prediction, pre hospital, traumatic shock