血清乳酸水平和乳酸清除率在评估新生儿窒息预后中的意义研究

Value of Serum Lactate Level and Lactate Clearance Rate in Predicting the Prognosis of Neonatal Asphyxia

目的探讨血清乳酸水平和乳酸清除率在评估新生儿窒息预后中的意义。方法选择2008年6月—2012年5月来我院接受治疗的135例窒息新生儿,根据预后分成死亡组34例和存活组101例。检测抢救前和抢救后1h、2 h、6 h血清乳酸水平以及抢救后1 h、2 h、6 h的乳酸清除率。绘制血清乳酸水平及乳酸清除率评估预后的受试者工作特征(ROC)曲线,计算曲线下面积(AUC)。结果死亡组与存活组抢救前及抢救后1 h、2 h、6 h血清乳酸水平比较,差异有统计学意义(F组间=2.435,P=0.027;F时间=4.378,P=0.012);其中组间两两比较,差异均有统计学意义(P<0.05);组内两两比较,差异均有统计学意义(P<0.05)。死亡组和存活组抢救后1 h、2 h、6 h乳酸清除率比较,差异有统计学意义(F组间=8.348,P=0.018;F时间=7.946,P=0.035);其中组间两两比较,差异均有统计学意义(P<0.05);组内两两比较,差异均有统计学意义(P<0.05)。抢救前、抢救后1 h、2 h和6 h血清乳酸清水平评估预后的AUC分别为75.37%、87.29%、92.88%和99.95%。抢救后1 h、2 h和6 h乳酸清除率评估预后的AUC分别为82.15%、94.27%和97.04%。结论抢救后6 h的血清乳酸水平和乳酸清除率对于新生儿窒息预后具有较高的预测价值。

Objective To investigate the value of serum lactate level and lactate clearance rate in predicting the prog- nosis of neonatal asphyxia. Methods A total of 135 cases of neonatal asphyxia treated in our hospital between June 2008 and May 2012 were divided into the death group （ n = 34 ） and the survival group （ n = 101 ）. Serum lactate level before the rescue and at 1 h, 2 h and 6 h after the rescue, and lactate clearance rate at 1 h, 2 h and 6 h after the rescue were withdrawn. Receiv- er operating characteristic （ROC） curve involving the relationships between serum lactate level or lactate clearance rate and the prognosis was drawn, and area under curve （AUC） was calculated. Results Serum lactate levels between the death group and the survival group before rescue and at 1 h, 2 h, 6 h after rescue were significantly different （ Fbetweengroup = 2. 435, P = 0. 027 ; Ftime = 4. 378, P = 0. 012） ; Differences between groups and within each group were statistically significant （P 〈 0. 05 ）. Lactate clearance rate between the death group and the survival group at 1 h, 2 h, 6 h after rescue were significantly different （Fbetweengroup =8. 348, P =0. 018; Ftime =7. 946, P =0. 035） ; Differences between groups and within each group were statisti- cally significant （ P 〈 0.05 ）. The prognosis AUCs of serum lactic levels before rescue and at 1 h, 2 h, 6 h after rescue were 75.37% , 87.29% , 92. 88% and 99. 95% , respectively. The prognosis AUCs of lactate clearance rates at 1 h, 2 h and 6 h after rescue were 82. 15% , 94. 27%, and 97.04%, respectively. Conclusion Serum lactate level and lactate clearance rate at 6 h after rescue have a high predictive value for the prognosis of neonatal asphyxia.