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目的:探讨血乳酸（Lac）、血清降钙素原（PCT）、序贯器官衰竭评分（SOFA）和急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）对脓毒性休克患者短期预后的评估价值。方法:采用回顾性研究方法，选择2015年4月至2019年6月在济宁医学院附属医院重症医学科住院治疗的脓毒性休克患者作为研究对象。收集患者性别、年龄、体重指数（BMI）、感染部位、器官功能情况，入住重症监护病房（ICU）即刻Lac、PCT、C-反应蛋白（CRP）、心率、体温，24 h内APACHEⅡ、SOFA评分和28 d预后情况等指标。根据28 d预后将患者分为存活组和死亡组，比较两组患者上述指标的差异。采用多因素Logistic回归分析筛选影响脓毒性休克患者28 d死亡的危险因素；绘制受试者工作特征曲线（ROC曲线）分析Lac、PCT、SOFA、APACHEⅡ、年龄对脓毒性休克患者28 d预后的预测价值。结果:共入组303例脓毒性休克患者，其中28 d存活124例，死亡179例，28 d病死率为59.08%。①与存活组比较，死亡组患者年龄偏大（岁：66.58±15.22比61.15±15.68），APACHEⅡ、SOFA、肺部感染比例、Lac水平明显增高〔APACHEⅡ（分）：22.79±7.62比17.98±6.88，SOFA（分）：9.42±3.51比5.65±1.59，肺部感染比例：53.63%（96/179）比39.52%（49/124），Lac（mmol/L）：5.10±3.72比3.71±2.56〕，氧合指数（PaOn 2/FiOn 2）、入住ICU体温明显降低〔PaOn 2/FiOn 2（mmHg，1 mmHg＝0.133 kPa）：198.94±80.15比220.68±72.06，入住ICU体温（℃）：37.47±1.08比37.80±1.14〕，差异均有统计学意义（均n P<0.05）。②多因素Logistic回归分析显示：校正潜在混杂因素后，APACHEⅡ评分、PCT、Lac、年龄、SOFA评分仍是影响脓毒性休克患者预后的独立危险因素〔APACHEⅡ：优势比（n OR）＝1.05，95%可信区间（95%n CI）为1.01～1.10，n P＝0.039；PCT：n OR＝0.99，95%n CI为0.98～1.00，n P＝0.012；Lac：n OR＝1.23，95%n CI为1.08～1.40，n P＝0.002；年龄：n OR＝1.03，95%n CI为1.01～1.05，n P＝0.009；SOFA评分：n OR＝1.88，95%n CI为1.59～2.22，n P<0.001〕。③ ROC曲线分析显示，APACHEⅡ、Lac、年龄、SOFA对脓毒性休克患者预后有一定的预测〔APACHEⅡ：ROC曲线下面积（AUC）＝0.682 4，95%n CI为0.621 7～0.743 1，n P＝0.000，当最佳截断值为18.500分时，其敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为72.63%、54.84%、69.89%、58.12%、1.608 1、0.499 2；Lac：AUC＝0.604 5，95%n CI为0.540 8～0.668 2，n P＝0.002，当最佳截断值为3.550 mmol/L时，其敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为50.84%、73.39%、73.39%、50.94%、1.910 3、0.669 9；年龄：AUC＝0.599 1，95%n CI为0.535 4～0.662 7，n P＝0.003，当最佳截断值为72.500岁时，其敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为42.46%、75.00%、71.03%、47.45%、1.698 3、0.767 2；SOFA：AUC＝0.822 3，95%n CI为0.776 7～0.867 9，n P＝0.000，当最佳截断值为7.500分时，其敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为68.72%、87.90%、89.13%、66.06%、5.680 4、0.355 9〕；且联合预测具有较高的敏感度（72.63%）和特异度（84.86%），AUC（0.876 5）高于单个变量的AUC，提示多变量联合预测脓毒性休克短期结局的准确性更高。n 结论:Lac、PCT、SOFA评分、APACHEⅡ评分、年龄是影响脓毒性休克患者短期死亡的独立危险因素；Lac、SOFA评分、APACHEⅡ评分、年龄联合预测脓毒性休克短期预后的准确性优于单个变量，诊断价值更高。“,”Objective:To explore the value of lactic acid (Lac), procalcitonin (PCT), sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in assessing the severity and predicting the prognosis in sepsis shock.Methods:A retrospectively study was conducted. Patients with septic shock hospitalized in the department of critical care medicine of the Affiliated Hospital of Jining Medical University from April 2015 to June 2019 were enrrolled. The patient's gender, age, body mass index (BMI), infection site, organ dysfunction status; Lac, PCT, C-reactive protein (CRP), heart rate and body temperature immediately after admission to the intensive care unit (ICU); APACHEⅡ and SOFA scores within 24 hours, and 28-day prognosis were collected. According to the 28-day prognosis, the patients with septic shock were divided into the survival group and the death group, and the differences in the indicators between the groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors of 28-day death in patients with septic shock; receiver operating characteristic curve (ROC curve) was used to analyze the value of Lac, PCT, SOFA, APACHEⅡ, and age in predicting the 28-day prognosis of patients with septic shock.Results:A total of 303 septic shock patients were enrolled, of which 124 cases survived and 179 died on the 28th day, and the 28-day mortality was 59.08%. ① Compared with the survival group, patients in the death group were older (years old: 66.58±15.22 vs. 61.15±15.68), APACHEⅡ, SOFA, proportion of lung infections, Lac increased [APACHEⅡ score: 22.79±7.62 vs. 17.98±6.88, SOFA score: 9.42±3.51 vs. 5.65±1.59, proportion of lung infections: 53.63% (96/179) vs. 39.52% (49/124), Lac (mmol/L): 5.10±3.72 vs. 3.71±2.56], oxygenation index (PaOn 2/FiOn 2) and ICU body temperature decreased [PaOn 2/FiOn 2 (mmHg, 1 mmHg = 0.133 kPa): 198.94±80.15 vs. 220.68±72.06, ICU body temperature (℃): 37.47±1.08 vs. 37.80±1.14], and the differences were statistically significant (all n P < 0.05).②Multivariate Logistic regression analysis results: after adjusted for potential confounding factors, APACHEⅡ, PCT, Lac, age and SOFA were independent risk factors for death in patients with septic shock [APACHEⅡ: odds ratio ( n OR) =1.05, 95% confidence interval (95%n CI) was 1.01-1.10, n P = 0.039; PCT: n OR = 0.99, 95%n CI was 0.98-1.00, n P =0.012; Lac: n OR = 1.23, 95%n CI was 1.08-1.40, n P = 0.002; age: n OR = 1.03, 95%n CI was 1.01-1.05, n P =0.009; SOFA score: n OR =1.88, 95%n CI was 1.59-2.22, n P < 0.001]. ③ROC curve analysis showed that APACHEⅡ, Lac, age and SOFA could predict the prognosis of patients with septic shock [APACHEⅡ: the area under the ROC curve (AUC) = 0.682 4, 95% n CI was 0.621 7-0.743 1, n P = 0.000; when the best cut-off value was 18.500, its sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 72.63%, 54.84%, 69.89%, 58.12%, 1.608 1 and 0.499 2, respectively. Lac: AUC = 0.604 5, 95%n CI was 0.540 8-0.668 2, n P = 0.002; when the best cut-off value was 3.550 mmol/L, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 50.84%, 73.39%, 73.39%, 50.94%, 1.910 3 and 0.669 9, respectively. Age: AUC = 0.599 1, 95%n CI was 0.535 4-0.662 7, n P = 0.003; when the best cut-off value was 72.500 years old, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 42.46%, 75.00%, 71.03%, 47.45%, 1.698 3 and 0.767 2, respectively. SOFA: AUC =0.822 3, 95%n CI was 0.776 7-0.867 9, n P = 0.000; when the best cut-off value was 7.500, its sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 68.72%, 87.90%, 89.13%, 66.06%, 5.680 4, 0.355 9 respectively]. The combined prediction had a good sensitivity (72.63%) and specificity (84.86%), and AUC (0.876 5) was higher than that of a single variable, suggested that the multivariate combination was more accurate in predicting the short-term outcome of septic shock.n Conclusion:Lac, PCT, SOFA score, APACHEⅡ score and age were independent risk factors for death in patients with septic shock, and the accuracy of Lac, SOFA score, APACHEⅡ score and age in predicting short-term prognosis of septic shock was better than that of single variable, and the diagnostic value was higher.