血乳酸水平与脓毒症心肌损伤的关系及对患儿预后的评估价值

Relationship between blood lactic acid level and myocardial injury in children with sepsis and its application value in prognosis evaluation

目的探讨血乳酸(Lac)水平与脓毒症患儿心肌损伤的关系及其对患儿预后的评估价值,以为临床上脓毒症症患儿的诊治提供指导。方法回顾性分析2014年10月至2017年8月期间开平市中心医儿科收治的53例脓毒症患儿的临床资料,按病情严重程度将其分为普通脓毒症组(n=17)、严重脓毒症组(n=23)和脓毒症休克组(n=13)。根据患儿治疗后预后情况,将其分为死亡组(n=17)和存活组(n=36)。比较不同病情程度患儿Lac及心肌损伤指标[肌红蛋白(Myo)及心肌肌钙蛋白I(c Tn I)]水平,并比较不同预后患儿血Lac水平的动态变化。结果脓毒症休克组、严重脓毒症组患儿血Lac、Myo、c Tn I水平分别为(8.18±3.52)mmol/L、(682.39±286.46)ng/mL、(0.012±0.004)μg/mL和(4.95±1.99)mmol/L、(120.96±42.39)ng/mL、(0.029±0.011)μg/mL,明显高于普通脓毒症组的(2.12±0.78)mmol/L、(50.18±20.57)ng/mL、(0.012±0.004)μg/mL,脓毒症休克组又高于严重脓毒症组,差异均有统计学意义(P<0.05);Pearson相关分析显示,血Lac水平与血Myo、c Tn I水平均呈正相关性(r=0.374、0.391,P<0.05);入院时及入院后24 h、48 h、72 h,死亡组患儿血Lac水平分别为(3.09±1.28)mmol/L、(2.38±0.95)mmol/L、(1.68±0.53)mmol/L、(1.24±0.44)mmol/L,均明显高于存活组的(8.64±3.15)mmol/L、(9.92±4.02)mmol/L、(12.57±4.86)mmol/L、(15.26±5.69)mmol/L,差异均有统计学意义(P<0.05)。结论脓毒症患儿血乳酸水平与心肌损伤及病情严重程度关系密切,可作为预后的重要预测指标,监测血Lac的动态变化对预后判断的应用价值更高。

Objective To investigate the relationship between blood lactic acid（Lac） level and myocardial injury in children with sepsis and its value in the evaluation of prognosis, so as to provide guidance for the clinical diagnosis and treatment of children with sepsis. Methods The clinical data of 53 children of sepsis treated in Department of Pediatrics, Kaiping Central Hospital from October 2014 to August 2017 were analyzed retrospectively. The children were divided into general sepsis group（n=17）, severe sepsis group（n=23） and septic shock group（n=13） according to the degree of the disease. According to the prognosis of the children after treatment, they were divided into death group（n=17）and survival group（n=36）. The levels of Lac and myocardial injury index（myoglobin [Myo] and cardiac troponin I [c Tn I]） in children with different severity of illness were compared, and the dynamic changes of blood Lac level in different prognosis were compared. Results The blood Lac, Myo and c Tn I in sepsis shock group, severe sepsis group were（8.18 ± 3.52） mmol/L,（682.39 ± 286.46） ng/mL,（0.012 ± 0.004） μg/mL and（4.95 ± 1.99） mmol/L,（120.96 ± 42.39） ng/mL,（0.029 ± 0.011） μg/mL, respectively, which were significantly higher than（2.12 ± 0.78） mmol/L,（50.18 ± 20.57） ng/mL,（0.012±0.004） μg/mL in general sepsis group, and the levels in the septic shock group were higher than those in severe sepsis group, with statistically significant difference（P〈0.05）. Pearson correlation analysis showed that the level of blood Lac and blood Myo, c Tn I had positive correlation（r=0.374, 0.391, P〈0.05）. At different time points（on admission, 24 hours after admission, 48 h after admission, 72 h after admission）, the blood Lac level in death group was（3.09±1.28） mmol/L,（2.38 ± 0.95） mmol/L,（1.68 ± 0.53） mmol/L,（1.24 ± 0.44） mmol/L, respectively, which was significantly higher than（8.64±3.15） mmol/L,（9.92±4.02） mmol/L,（12.57±4.86） mmol/L,（15.26±5.69） mmol/L in survival group（P〈0.05）. Conclusion Blood Lac level in children with sepsis is closely related to myocardial injury and the severity of the disease. It can be used as an important predictor of prognosis, and monitoring the blood Lac dynamic changes has high valuable in predicting prognosis.