动脉血乳酸水平与早期乳酸清除率在新生儿窒息严重程度判断及预后评估中的价值

To explore the value of arterial blood lactate level and early lactate clearance rate in the severity and prognosis of neonatal asphyxia

目的探讨新生儿窒息患儿动脉血乳酸水平与早期乳酸清除率在新生儿窒息脏器损害严重程度及预后中的判断价值。方法选取2017年8月-2018年8月蚌埠医学院第二附属医院儿科新生儿病房收治的符合纳入标准的134例新生儿窒息患儿为研究对象,记录入院初始动脉血乳酸水平和治疗6 h后动脉血乳酸水平。分组方法:①按新生儿娩出后1 min Apgar评分分组,0~3分为重度窒息组,4~7分为轻度窒息组,比较2组动脉血乳酸初始水平和治疗6 h后水平;②按治疗6 h后动脉血乳酸清除率的高低,分为乳酸高清除率组(乳酸清除率≥10%)和乳酸低清除率组(乳酸清除率<10%)。观察2组患儿在随后的治疗过程中发生多脏器损伤的不良预后情况,分析评价早期乳酸清除率在新生儿窒息严重程度判断及预后评估中的价值。结果动脉血乳酸初始浓度、治疗6 h后浓度2组间和组内比较,差异有统计学意义(均P<0.05)。乳酸高清除率组中发生多脏器损伤26例,未发生65例,发生率为28.6%;乳酸低清除率组中发生多脏器损伤29例,未发生14例,发生率为67.4%;2组经χ~2检验,差异有统计学意义(χ~2=18.233,P<0.001)。结论窒息新生儿的动脉血乳酸水平与窒息程度有着较高的相关性,动脉血乳酸水平越高,反映出窒息新生儿的窒息程度越严重。早期(6 h)乳酸清除率在新生儿窒息发生多脏器损害的预后评估中有着重要意义,早期(6 h)乳酸清除率越高,发生多脏器损害的可能性越低。

Objective To explore the value of arterial lactate level and early lactate clearance in the severity and prognosis of neonatal asphyxia. Methods A total of 134 neonatal asphyxia patients enrolled in our department from August 2017 to August 2018 were selected as study subjects, and arterial blood lactate levels at the initial admission and 6 h after treatment were recorded. Two times of grouping and data comparison analysis were performed:①Apgar score 1 minute after delivery of neonates was divided into groups: 0-3 for severe asphyxia group and 4-7 for mild asphyxia group. To compare the initial level of arterial blood lactic acid between the two groups and the level of arterial blood lactic acid after 6 h of treatment, and to compare and analyze the differences.②According to the 6 h arterial blood lactic acid clearance rate, it was divided into the high lactic acid clearance rate group(lactic acid clearance rate is more than 10%) and the low lactic acid clearance rate group(lactic acid clearance rate < 10%). To observe the poor prognosis of the two groups of children with multiple organ injuries during subsequent treatment and analyze and evaluate the value of early lactate clearance rate in the severity judgment and prognosis evaluation of neonatal asphyxia. Results There were statistically significant differences between the two groups in the initial concentration of arterial blood lactic acid and the concentration after 6 h of treatment(all P<0.05). In the lactate high clearance group, multiple organ injuries occurred in 26 cases, but did not occur in 65 cases, with an incidence rate of 28.6%. Furthermore, 29 cases of multiple organ injuries occur in the low lactic acid clearance rate group, while 14 cases didn’t occur(67.4%). The chi-square test showed statistical significance(χ~2=18.233,P<0.001). Conclusions The level of arterial blood lactic acid in asphyxiated neonates is correlated with the degree of asphyxiation. The higher the level of lactic acid in arterial blood, the more severe the degree of asphyxiation of neonates. The early(6 h) lactate clearance rate is of great significance in the prognosis evaluation of neonatal asphyxia with multiple organ damage. The higher the lactate clearance rate in the early stage(6 h), the lower the possibility of multiple organ damage.