重症肺炎患儿血乳酸监测的临床意义

Clinical significance of monitoring of blood lactic acid level for severe pneumonia children aged less than 5years

目的探讨血乳酸动态水平与<5岁重症肺炎患儿病情及预后的关系。方法选取2010年1月-2014年12月<5岁重症肺炎患儿75例,根据血乳酸水平分为乳酸正常组26例及乳酸升高组49例,分别记录两组患儿症状体征消失天数、并发症发生率、机械通气率、预后及住院天数,统计治疗有效与无效患儿的初始乳酸水平、乳酸峰值及6、12h乳酸清除率;采用SPSS14.0软件对数据进行统计分析。结果乳酸升高组气促消失、发绀消失、下胸壁凹陷消失时间、肺部啰音消散时间明显偏长,而并发症、机械通气例数明显增多,治疗有效例数减少,住院天数增多,与乳酸正常组比较差异均有统计学意义(P<0.01);治疗有效患儿和治疗无效患儿相比,入院时血乳酸差异无统计学意义,但治疗有效患儿乳酸峰值低及6、12h乳酸清除率高,差异均有统计学意义(P<0.01)。结论血乳酸水平能反应<5岁重症肺炎患儿病情轻重,乳酸峰值、早期乳酸清除率是评价预后的良好指标。

OBJECTIVE To explore the relationship between the dynamic level of blood lactic acid and the illness condition and prognosis of severe pneumonia children aged less than 5years.METHODS From Jan 2010 to Dec2014,a total of 75 children with severe pneumonia who were aged less than 5years old were enrolled in the study and divided into the normal lactic acid group with 26 cases and the elevated lactic acid group with 49 cases according to the level of blood lactic acid.The duration of disappearance of symptoms,incidence of complications,rate of mechanical ventilation,prognosis,and length of hospital stay were recorded for the two groups of children;the initial level of lactic acid,peak level of lactic acid,and clearance rates of lactic acid at 6and 12 hours were taken for statistics for the children who were effective for treatment and those who were not,and the statistical analysis of data was performed with the use of SPSS14.0software.RESULTS The time of disappearance of breath shortness,cyanosis,chest wall sag,and pulmonary rales was significantly longer in the elevated lactic acid group than those in the normal lactic acid group;the number of cases of complications or mechanical ventilation was remarkably increased,the number of cases effective for treatment was reduced,the length of hospital stay was increased,as compared with the normal lactic acid group,there was significant difference（P〈0.01）.There was no significant difference in the blood lactic acid level between the effective cases and the ineffective cases at the time of admission,however,the effective cases had significantly lower peak level of blood lactic acid and higher clearance rates of lactic acid at 6and 12hours（P〈0.01）.CONCLUSIONThe blood lactic acid level can reflect the severity of the severe pneumonia children aged less than 5years old;the peak level of lactic acid and early clearance rate of lactic acid are the favorable indicators for evaluation of prognosis.