血乳酸在判断新生儿败血症预后中的临床价值

Clinical value of blood lactate in predicting the prognosis of neonatal sepsis

目的探讨动脉血乳酸水平在判断新生儿败血症预后中的临床价值.方法收集301例败血症新生儿的临床资料,主要包括入院时血乳酸、C反应蛋白、降钙素原等生化指标.通过ROC曲线分析,评估入院时血乳酸水平对判断新生儿败血症预后的价值.结果足月儿血乳酸重度升高组病死率(26.1%)较轻度升高组(3.1%)和乳酸正常组(0%)明显升高(P<0.017).预后不良组入院时血乳酸水平(6.5±5.1 mmol/L)较预后良好组(3.6±1.7 mmol/L)明显升高(P<0.05).入院时血乳酸水平(临界值为6.15 mmol/L)对判断新生儿败血症预后的敏感性和特异性分别为0.545、0.919.结论早期血乳酸水平可作为判断新生儿败血症预后的生化指标,特异性高,但敏感性较低.

Objective To explore the clinical value of arterial blood lactate level in predicting the prognosis of neonatal sepsis. Methods The clinical data of 301 cases of neonatal sepsis were collected,which mainly included biochemical indicators such as blood lactate on admission,C-reactive protein,and procalcitonin. ROC curves were plotted to evaluate the value of lactate level on admission in predicting the prognosis of neonatal sepsis. Results The mortality rate was significantly higher for full-term infants in the severely-elevated lactate group than in the mildlyelevated lactate group and the normal lactate group(26.1% vs 3.1% and 0%;P<0.017). The poor prognosis group had a significantly increased lactate level on admission compared with the good prognosis group(6.5±5.1 mmol/L vs 3.6±1.7 mmol/L;P<0.05). The sensitivity and specificity of blood lactate level on admission(cutoff value:6.15 mmol/L) were0.545 and 0.919 respectively,in predicting the prognosis of neonatal sepsis. Conclusions Early blood lactate level can be used as a biochemical parameter to predict the prognosis of neonatal sepsis as it has a high specificity but a low sensitivity.