儿童危重病例评分法及血乳酸水平在评估重症手足口病患儿中的价值

Value of Pediatric Critical Illness Score and Blood Lactic Acid Level in Children with Severe Hand,Foot and Mouth Disease

目的:探讨儿童危重病例评分法(PCIS)及血乳酸水平在评估重症手足口病(HFMD)患儿中的价值。方法:选取60例HFMD患儿,根据入院PCIS评分结果将其分为普通组(n=25)与重症组(n=35),另收集同龄健康儿童30例为对照组。各组均进行血乳酸检测,比较各组以及患儿不同治疗结局、不同乳酸清除率的血乳酸水平及PICS评分。结果:治疗前,重症组血乳酸水平均高于普通组、对照组,且普通组血乳酸水平高于对照组,重症组PICS评分低于普通组,差异均有统计学意义(P<0.05);治疗后,两组血乳酸水平均低于治疗前、PICS评分均高于治疗前,且重症组血乳酸水平高于普通组、PICS评分低于普通组,差异均有统计学意义(P<0.05);60例患儿中,存活55例(高乳酸清除率组)、死亡5例(低乳酸清除率组),死亡组血乳酸水平高于存活组、PICS评分低于存活组,低乳酸清除率组PCIS评分低于高乳酸清除率组,差异均有统计学意义(P<0.05);PCIS评分、血乳酸对分辨危重病例是否发生死亡的AUC(95%可信区间)分别为0.82(0.74,0.91)、0.75(0.62,0.88)。结论:PCIS评分和血乳酸水平检测,均能较好预测危重症HFMD患儿的患病情况及预后,值得推广。

Objective:To explore the value of pediatric critical illness score(PCIS)and blood lactate level in assessment of children with severe hand,foot and mouth disease(HFMD).Method:60 children with HFMD were selected,according to the results of admission PCIS score,they were divided into normal group (n=25)and severe group(n=35),and 30 healthy children of the same age were collected as control group.Blood lactic acid was detected in all groups.The blood lactate levels and PICS scores of each group and children with different treatment outcomes,different lactate clearance rates were compared.Result:Before treatment,the blood lactate level in severe group were higher than those of normal group and control group,the blood lactate level in normal group was higher than that of control group,the PICS score in severe group was lower than that of normal group,the differences were statistically significant(P<0.05).After treatment,the blood lactate level of two groups were lower than those of before treatment and the PICS score were higher than those of before treatment,the blood lactate level of severe group was higher than that of normal group and PICS score was lower than that of normal group,the differences were statistically significant(P<0.05).60 children,55 children survived(high lactate clearance group)and 5 children died(low lactate clearance group),the blood lactate level in death group was higher than that of survival group and the PICS score was lower than that of survival group,PCIS score of low lactate clearance group was lower than that of high lactate clearance group,the differences were statistically significant (P<0.05).The AUC(95% confidence interval)of PCIS score and blood lactate for distinguishing death in critical cases were 0.82(0.74,0.91)and 0.75(0.62,0.88).Conclusion:PCIS score and blood lactate level detection can better predict the prevalence and prognosis of severe HFMD children,which is worthy of promotion.