早期乳酸清除率判断危重患儿预后的临床意义

Clinical significance of early lactate clearance rate in judging prognosis of critical illness in pediatrics

目的初步探讨早期血乳酸清除率在危重患儿预后判断中的作用。方法选择新乡医学院第一附属医院儿科重症监护病房(PICU)2010年5月至2012年5月收治的小儿危重病例评分(PCIS)<80分、存活时间>6 h的患儿。在患儿入住PICU 1 h内(治疗前)进行危重症评分,行动脉血气分析并测定血乳酸水平,治疗6 h再次观测上述指标,计算6 h乳酸清除率。根据预后将患儿分为存活组和死亡组,比较2组动脉血乳酸清除率与乳酸水平的差异。结果存活组和死亡组治疗前动脉血乳酸水平、PCIS比较差异无统计学意义(P>0.05);2组间治疗后血乳酸水平和血乳酸清除率比较差异有统计学意义(P<0.05)。结论早期乳酸清除率可作为危重患儿预后判断的一个良好指标。

Objective To investigate the clinical significance of early lactate clearance rate in judging prognosis of critical illness.Methods Infants with critical illness whose survival time was more than 6 hours and pediatric critical illness score（PCIS） less than 80 in pediatric intensive care unit of the First Affiliated Hospital of Xinxiang Medical University from May 2010 to May 2012 were chosen.The PCIS,arterial blood lactate and arterial blood gas analysis were measured in one hour before treatment and 6 hours after treatment respectively,and then the 6 hours arterial blood lactate acid clearance rate was calculated.The patients were divided into survival group and death group depending on prognosis,and the differences of arterial blood lactate acid clearance rate and lactate level between them were compared.Results There was no statistical difference in PCIS and arterial blood lactate level before treatment between survival group and death group（P〈0.05）while the differences were statistic after treatment（P〈0.05）.Conclusion Early arterial blood lactate clearance rate could be a good index for judging the prognosis of patients with critical illness in pediatrics.