动脉血乳酸对于新生儿休克严重程度和预后判断的价值

Value of arterial blood lactic acid in the evaluation of disease severity and prognosis in neonatal shock

目的探讨血乳酸对新生儿休克严重程度及预后判断的价值。方法 326例休克新生儿(轻度147例、中度105例、重度休克74例)在复苏同时及早期复苏后(约6h)检测动脉血乳酸并计算乳酸清除率。采用受试者工作特征曲线(ROC曲线)评价血乳酸对新生儿休克的预测效能。结果治疗前休克患儿的血乳酸均增高,以重度组最高、轻度组最低(P<0.01);感染性休克、低血容量性休克、心源性休克和窒息性休克患儿的血乳酸水平以感染性休克最高(P<0.05);治疗后进入恢复期的休克患儿血乳酸水平明显下降(P<0.05)。血乳酸≤4mmo/L休克患儿的病死率低于乳酸>4mmo/L患儿(P<0.01);乳酸清除率<10%患儿的死亡风险高于清除率≥10%患儿(P<0.01)。血乳酸为11.15mmol/L时,对重度休克预测的灵敏度为100%、特异度为96.8%;血乳酸为10.65mmol/L时,对休克患儿死亡风险预测的灵敏度为88.9%、特异度为74.1%。结论动脉血乳酸水平随新生儿休克严重程度而增加,且与预后相关,可用于休克严重程度及预后判断。

Objective To evaluate the value of blood lactic acid（BLA） as a predictor for the severity and prognosis of neonatal shock. Methods A total of 326 neonates with shock were enrolled and divided into three groups based on the severity, namely mild group（n=147）, moderate group（n=105）, and severe group（n=74）. BLA level was measured during and early after（about 6 hours later） fluid resuscitation, and lactate clearance rate（LCR） was calculated. The receiver operating characteristic（ROC） curve was applied to evaluate the predictive value of BLA in neonatal shock. Results BLA level was high in all subjects prior to treatment, and was highest in the severe group and lowest in the mild group（P〈0.01）. BLA level was significantly higher among patients with septic shock than among those with hypovolemic, cardiogenic, and asphyxiating shock（P〈0.05）. BLA level was significantly reduced in patients in recovery after treatment（P〈0.05）. Mortality was significantly lower in patients with BLA level ≤4 mmol/L or LCR ≥10% than in those with BLA level 〉4 mmol/L or LCR 〈10%（P〈0.01）. BLA at 11.15 mmol/L had 100% sensitivity and 96.8% specificity in predicting severe shock. BLA at 10.65 mmol/L had 88.9% sensitivity and 74.1% specificity in predicting the prognosis（survival or dead） of newborns with shock. Conclusions In neonates with shock, arterial BLA level increases as the disease severity increases and is associated with prognosis, so it is a useful predictor of the severity and prognosis of neonatal shock.