小儿脓毒性休克早期血乳酸浓度与病情严重程度的相关性分析

Analysis of the Relationship between Blood Lactic Acid Concentration and Severity of Septic Shock in Children

目的:探讨早期动态监测血乳酸浓度对评价小儿脓毒性休克病情严重程度与预后的价值。方法:入选90例小儿脓毒性休克患儿,以诊断休克为研究起点,动态监测研究0 h、6 h的血乳酸,计算6 h乳酸清除率。按PCIS评分分为≥70分组(n=41)、60~70分组(n=40)、<60分组(n=9);按预后分为存活组(n=62)与死亡组(n=28);按乳酸清除率分为高乳酸清除率组(n=57)与低乳酸清除率组(n=33),对各组PCIS评分、0 h血乳酸及乳酸清除率等指标进行比较。结果:≥70分组、60~70分组、<60分组0 h血乳酸及乳酸清除率比较差异有计学意义(P<0.05),≥70分组明显低于60~70分组及<60分组,60~70分组明显低于<60分组(P均<0.05);存活组PCIS评分及乳酸清除率显著高于死亡组,0 h血乳酸水平明显低于死亡组(P<0.05);高乳酸清除率组PCIS评分显著高于低乳酸清除率组。PCIS评分与0 h血乳酸浓度呈显著负相关(r=-0.619,P<0.05),与乳酸清除率呈显著正相关(r=-0.702,P<0.05)。结论:在评价小儿脓毒性休克的病情严重程度及预后方面,早期血乳酸清除率比单次血乳酸浓度更有意义。

Objective： To investigate the value of early dynamic monitoring of blood lactic acid concentration in evaluating the severity and prognosis of septic shock in children. Methods： 90 children with septic shock were enrolled in this study, starting with diagnostic shock, blood lactate at 0 h and 6 h were dynamically monitored, and 6 h lactate clearances were calculated. According to PCIS scores, they were divided into 〉 70 points group（n=41）, 60-70 points group（n=40） and 〈60 points group（n=9）; according to the prog-nosis, they were divdided into survival group （n=62） and death group （n=28）; according to the lactate clearance rate, they were divdided into high lactate clearance rate group （n=57） and low lactate clearance rate group （n=33）. The PCIS score, 0 h lactic acid and lactate clearance rate of each group were compared. Results： There were significant in 0 h lactic acid and lactate clearance rate among ~ 70 points group, 60-70 points group and 〈60 points group （P〈0.05）. The 0 h lactic acid and lactate clearance rate in ~ 70 points group were lower than those in the 60-70 points group, which were lower in 〈60~70 points group than than that in 〈60 points group （P〈 0.05）. There were significant differences in the PCIS scores, 0 h lactic acid and lactate clearance rate between survival group and death group（P〈0.05）. There were significant differences in the PCIS scores between high lactate clearance rate group and low lactate clearance rate group（P〈0.05）. PCIS score was negative correlated with Oh lactate concentration （r=-0.619）, and was positively correlated with the lactate clearance （r=-0.702）. Conclusions： In the evaluation of the severity and prognosis of septic shock in children, early lactate clearance rate was more useful than that of single blood lactate acid.