血乳酸和乳酸清除率与重症脓毒症患儿的预后关系

The relationship between blood lactic acid and lactic acid clearance and severe sepsis in children

目的:探讨动脉血乳酸及乳酸清除率动态监测在重症脓毒症患儿预后的临床关系。方法:对收治的重症脓毒症患儿42例入院后均按重症脓毒症的诊断指南中的诊疗方案进行治疗,测定每例患儿复苏前及复苏后动脉血乳酸值,并且计算复苏后1、2、6 h的乳酸清除率。根据预后分为存活组20例与死亡组22例,评价早期乳酸和乳酸清除率与预后的关系。结果:存活组复苏前及复苏后1、2、6 h的乳酸值明显低于死亡组,差异有统计学意义(P<0.05)。存活组复苏后1、2、6 h的乳酸清除率明显高于死亡组,差异有统计学意义(P<0.05)。结论 :动态监测动脉血乳酸及乳酸清除率是判断重症脓毒症患儿预后和病情严重程度的一个良好指标,动脉血乳酸越高病情越重,预后越差;血乳酸清除率越低病情越重,预后越差。

Objective： To discuss arterial blood lactic acid and lactic acid clearance dynamic monitoring in children with severe sepsis the prognosis of clinical relationship. Methods： 42 patients with severe sepsis were selected, all subjects were after admission to the diagnosis of severe sepsis in the guide diagnosis and treatment plan. Blood lactic acid value was detected before and after recovery, and lac-tic acid clearance was calculated after 1 h, 2 h, 6 h after recovery. According to the prognosis, subjects were divided into live group （n = 20） and death group （n = 22 ）. Early lactic acid and lactic acid clearance and the relationship between the prognosis were evaluated. Results： ① Lactic acid value in live group before and after recovery 1 h, 2 h, 6 h was significantly lower than that of the death group （ P 〈 0. 05） . ② Lactic acid clearance in live group recovery after 1 h, 2 h, 6 h was obviously higher than that of the death group （ P 〈 0. 05） . Conclusion： Dynamic monitoring blood lactic acid and lactic acid clearance are judgment severe sepsis patients prognosis and the severity of the illness of a good index, arterial blood lactic acid is higher, the illness is heavier and the worse prognosis. Blood lactic acid clearance rate is lower, the illness is heavier, the worse the orognosis.