乳酸和早期乳酸清除率预测严重脓毒症患儿预后的临床价值

Clinical Value of Lactate and Early Lactate Clearance Rate on Evaluation of Prognosis in Children with Severe Sepsis

目的探讨动脉血乳酸及早期乳酸清除率在严重脓毒症患儿预后判断中的临床意义。方法选取2008年6月-2011年6月南京医科大学附属南京儿童医院PICU 145例严重脓毒症患儿,以患儿入住PICU为研究起点(0 h),进行小儿危重病例评分(PCIS)、测定其动脉血乳酸水平;治疗6 h后再次测定其动脉血乳酸水平,计算6 h乳酸清除率。以6 h乳酸清除率分为高乳酸清除率(乳酸清除率≥10%)组和低乳酸清除率(乳酸清除率<10%)组,比较2组患儿的病死率;根据预后将患儿分为存活组和死亡组,比较2组动脉血乳酸水平及6 h乳酸清除率;以入院时乳酸水平(<2.0 mmol·L-1、2.0～3.9 mmol·L-1、≥4.0 mmol·L-1)分为3组,比较3组间的病死率、PCIS。结果高乳酸清除率组患儿病死率显著低于低乳酸清除率组(χ2=41.01,P<0.01);死亡组与存活组乳酸水平和6 h乳酸清除率比较差异均有统计学意义(t=6.77、9.23,Pa<0.01);不同乳酸水平组间病死率和PCIS比较差异均有统计学意义(χ2=18.996,P<0.01;F=58.660,P<0.01)。结论早期检测乳酸水平和6 h乳酸清除率可有效判断严重脓毒症患儿病情的危重程度和预后。

Objective To explore the clinical prognostic significance of arterial blood lactate and its early clearance rate in children with severe sepsis. Methods One hundred and forty - five children with severe sepsis admitted into Pediatric Intensive Care Unit of Nanjing Children＇s Hospital Affiliated to Nanjing Medical University from Jun. 2008 to Jun. 2011 were collected in this study. The pediatric critical illness score（FCIS） and arterial blood lactate were measured when admitted and 6 h later after treatment respectively, and then the 6 h lactate clearance rate was calculated in all patients. The children were divided into survival group and death group from hospital admission to discharge or death of the patients. According to 6 h lactate clearance rate ,the children were divided into the high lactic acid clearance rate （ ≥ 10% ） group and the low lactic acid clearance rate（ 〈 10% ） group . The children were also divided into 3 groups according to different lactic acid levels （ 〈 2.0 mmol · L - 1,2.0 - 3.9 mmol · L - 1, I〉 4.0 mmol · L - 1 ）, while the mortality and PCIS were compared respectively. Results Mortality of high lactate clearance rate group was significantly lower than that of the low lactic acid clearance rate group（χ2 = 41.01, P 〈 0.01 ）. The lactate level and 6 h lactate clearance rate of the survival group were significantly lower and higher respectively than those of the death group（t = 6. 77,9. 23 ,Pa 〈 0.01 ）. There were significant differences in mortality and PCIS among different lactate level groups （χ2 = 18. 996,P 〈 0.01 ;F = 58. 660,P 〈 0.01 ）. Conclusion Lactic acid level and early lactate clearance rate can be used as a marker for prognosis of patients with severe sepsis.