动态监测血乳酸对评估小儿脓毒症的临床意义

Clinical Significance of Dynamic Monitoring of Blood Lactic Acid in Estimating Sepsis in Children

目的探讨动态监测血乳酸水平对脓毒症患儿的病情评估和预后判断的临床意义。方法动态监测69例脓毒症患儿（脓毒症组）入住PICU后1 h内（治疗前）,6、12、244、8 h血乳酸水平的变化。并与同期进行健康体检的26例儿童（对照组）作对照。比较脓毒症组中有多脏器功能障碍（MODS）与无MODS者、存活与死亡者的血乳酸水平,并分析治疗前不同程度血乳酸水平与病死率之间的关系。结果脓毒症组治疗前的血乳酸水平明显高于对照组[（6.78±2.55）mmol·L-1vs（1.12±0.27）mmol·L-1,t=15.8、P〈0.001]。脓毒症组有MODS者的血乳酸水平明显高于无MODS者[（8.22±1.56）mmol·L-1vs（3.34±0.85）mmol·L-1,t=11.0、P〈0.001];死亡者在各个不同时期血乳酸水平都明显高于存活者（P〈0.001）;存活的患儿经过积极治疗后血乳酸水平逐步下降,在治疗48 h后基本恢复正常;而死亡者的血乳酸水平持续升高。治疗前正常（〈2.0 mmol·L-1）、中（≥2.0~3.9 mmol·L-1）、高（≥4.0 mmol·L-1）血乳酸水平的患儿,病死率分别为13%、22%、39%,血乳酸水平越高其病死率也随之升高。结论早期常规动态监测脓毒症患儿的血乳酸水平变化有利于临床评估病情、评判治疗效果和预测预后。

Objective To explore the clinical significance of dynamic monitoring of blood lactic acid in estimating disease condition and prognosis in children with sepsis.Methods The levels of blood lactic acid in 69 children with sepsis（sepsis group） were dynamically monitored within 1 hour after admission to PICU（before treatment）,and 6,12,24 and 48 hours after admission.Twenty-six control subjects who received physical examination（control group） were selected for comparison.The levels of lactic acid were compared between sepsis group and control group,between sepsis children with multiple organ dysfunction syndrome（MODS） and sepsis children without MODS,and between survivors and non-survivors.The relationship between preoperative blood lactic acid levels and mortality was analyzed.Results Blood lactic acid levels in sepsis group were significantly higher than those in control group [（6.78±2.55） mmol·L-1 vs（1.12±0.27）mmol·L-1,t=15.8,P0.001）].Blood lactic acid levels in sepsis children with MODS were significantly higher than those in sepsis children without MODS [（8.22±1.56） mmol·L-1 vs（3.34±0.85）mmol·L-1,t=11.0,P0.001）.Blood lactic acid levels in survivors were significantly higher than those in non-survivors at different time points（P0.001）.Blood lactic acid levels decreased gradually and recovered to normal levels 48 hours after treatment in survivors,but continued to increase in non-survivors.The mortality was 13%,22% and 39% in sepsis children with normal（2.0 mmol·L-1）,intermediate（≥20-3.9 mmol·L-1） and high（≥4.0 mmol·L-1） levels of blood lactic acid before treatment,respectively.Conclusion Dynamic monitoring of blood lactic acid in children with sepsis was beneficial to estimation of patient＇s condition,treatment and prognosis.