重症手足口病患儿血乳酸浓度和清除率与疾病预后的相关性

Correlation between Lactic Acid Concentration,Clearance Rate and Disease Prognosis in Children with Severe Hand,Foot and Mouth Disease

目的:探讨重症手足口病患儿血乳酸浓度和清除率及其与疾病预后的相关性。方法:选取2016年10月至2018年3月我院收治的重症手足口病患儿120例,根据患儿病情严重程度分为非危重组(n=24)、危重组(n=49)、极危重组(n=47),采集动脉血检测血乳酸浓度,计算6 h乳酸清除率,观察血乳酸浓度和乳酸清除率变化与病情严重程度及预后的相关性。结果:危重组、极危重组患儿血乳酸浓度高于非危重组,乳酸清除率低于非危重组(P<0.05);治疗后血乳酸浓度为2.0~3.9 mmol/L组和≥4.0 mmol/L组病死率高于血乳酸浓度<2.0 mmol/L组,且小儿危重病例评分法(PCIS)评分低于<2.0 mmol/L组(P<0.05)。高乳酸清除率组的病死率和PCIS评分低于低乳酸清除率组(P<0.05)。相关性分析结果显示,动脉血乳酸浓度与PCIS评分呈正相关(r=0.68,P<0.01);乳酸清除率与PCIS评分呈负相关(r=-0.69,P<0.01)。结论:重症手足口病患儿血乳酸浓度越高,病情越严重,乳酸清除率越低,预后效果越差,病死率越高。血乳酸浓度和清除率变化可作为判断重症手足口病患儿病情危重程度以及预后的重要参考。

Objective:To probe into the correlation between lactic acid concentration,clearance rate and disease prognosis in children with severe hand,foot and mouth disease.Methods:Totally 120 children with severe hand,foot and mouth disease admitted into the Oct.2016 to Mar.2018 were extracted to be divided into the non-critically ill group(n=24),critically ill group(n=49)and the extremely critically ill group(n=47).Arterial blood was collected to detect lactic acid concentration,and the clearance rate was calculated at 6 h.Correlation between lactic acid concentration,clearance rate and disease prognosis in children with severe hand,foot and mouth disease was observed.Results:The lactic acid concentration of the critically ill group and the extremely critically ill group was higher than that of the non-critically ill group,the clearance rate was lower than that of the non-critically ill group.After treatment,the fatality rate of children with lactic acid concentration from 2.0 to 3.9 mmol/L and≥4.0 mmol/L was higher than that with lactic acid concentration<2.0 mmol/L(P<0.05),and the pediatric critical illness score(PCIS)was lower than that with lactic acid concentration<2.0 mmol/L(P<0.05).The fatality rate and PCIS of the high lactic acid clearance group were significantly lower than that of the low lactic acid clearance group(P<0.05).Correlation analysis showed that arterial lactic acid concentration was positively correlated with PCIS(r=0.68,P<0.01).lactic acid clearance rate was negatively correlated with PCIS(r=-0.69,P<0.01).Conclusion:The higher the lactic acid concentration in children with severe hand,foot and mouth disease,the more severe the disease,the lower the lactic acid clearance rate,the worse the disease prognosis,and the higher the fatality rate.Changes of lactic acid concentration and clearance rate can be used as an important reference to judge the severity and prognosis of children with severe hand,foot and mouth disease.