危重症患儿血乳酸水平与病情的关系

Relationship between blood lactate level and disease severity in critically ill children

目的探讨危重症患儿血乳酸水平与病情的关系。方法回顾性分析2010年9月至2010年12月232例危重症患儿的临床资料。根据入院后患儿的血乳酸水平分为乳酸水平正常组(n=146)、高乳酸血症组(n=72)和乳酸酸中毒组(n=14),比较3组危重症患儿循环功能、小儿危重病例评分及预后。结果不同乳酸水平患儿间脓毒血症程度的比较差异有统计学意义(χ2=13.592,P<0.01)。乳酸酸中毒组脓毒症休克发生的比例(42.9%)较乳酸水平正常组(7.5%)、高乳酸血症组(11.1%)明显升高。不同乳酸水平患儿小儿危重病例评分也不同,3组比较差异有统计学意义(χ2=12.854,P<0.05)。全血乳酸水平与小儿危重病例评分呈明显负相关(r=-0.405,P=0.002)。不同乳酸水平患儿预后亦不同(χ2=25.599,P<0.01)。乳酸酸中毒组的治愈率明显低于乳酸水平正常组(7.1%vs 23.3%,P<0.05);乳酸酸中毒组的好转率亦明显低于乳酸水平正常组(28.6%vs58.2%,P<0.05),而其病死率(28.6%)明显高于乳酸水平正常组(5.5%)及高乳酸血症组(6.9%),差异有统计学意义(P<0.05)。结论患儿血乳酸水平越高,病情越危重,预后越差。

Objective To study the relationship between blood lactate level and disease severity in critically ill children.Methods The clinical data of 232 children who were critically ill between September and December,2010 were retrospectively studied.According to blood lactate levels within 24 hrs of admission,the 232 patients were classified into three groups： normal（n=146）,high lacticemia（n=72） and lactic acidosis（n=14）.The circulation functions,pediatric critical illness scores and prognosis were compared among the three groups.Results The degree of sepsis among the three groups was different（χ2 = 13.592,P0.01）.The occurrence of septic shock in the lactic acidosis group（42.9%） was significant compared with that in the normal（7.5%） and the high lacticemia groups（11.1%）.The pediatric critical illness scores were different among the three groups（χ2 = 12.854,Ρ0.05）.The blood lactate level was significantly negatively correlated with the pediatric critical illness scores（r=-0.405,P=0.002）.The prognosis among the three groups was also varied（χ2 = 25.599,P0.01）.The curative rate（7.1% vs 23.3%;Ρ0.05） and the improvement rate（28.6% vs 58.2%;P0.05） in the lactic acidosis group were significantly lower than in the normal group,and the mortality（28.6%） was significantly higher than in the normal（5.5%） and the high lacticemia groups（6.9%）.Conclusions A higher blood lactic acid level is associated with a more severe illness state and a worse prognosis.