乳酸和乳酸清除率对窒息新生儿脑损伤的评价作用

Evaluation of lactic acid and lactate clearance in brain injury of asphyxia neonates

目的分析动脉血乳酸和乳酸清除率早期评价窒息新生儿脑损伤的价值,为新生儿脑损伤的早期识别提供参考。方法回顾性分析2016年5月-2019年5月入住深圳市龙岗中心医院新生儿科的新生儿窒息病例129例。根据是否具有神经系统症状或异常振幅整合脑电图监测结果患儿分为脑损伤组(n=83)和无脑损伤组(n=46),分析两组患儿动脉血pH、碱剩余、乳酸和乳酸清除率的差异。分析不同乳酸水平和乳酸清除率患儿的脑损伤率、预后不良率及病死率情况。采用受试者工作特征(ROC)曲线评价动脉血乳酸和乳酸清除率对窒息新生儿脑损伤的预测效能。结果脑损伤患儿死亡9例,幸存者中预后不良26例、预后良好48例。脑损伤组患儿生后1 h内动脉血pH和碱剩余均显著低于无脑损伤组,而乳酸水平明显高于无脑损伤组,差异均有统计学意义(t=10.159、9.023、9.917,P<0.01)。脑损伤组患儿治疗后6 h动脉血pH和乳酸清除率低于无脑损伤组,而乳酸水平高于无脑损伤组,差异均有统计学意义(t=4.869、9.708、9.917,P<0.05);两组患儿治疗后6 h的碱剩余比较,差异无统计学意义(t=1.732,P>0.05)。高乳酸组患儿的脑损伤率、预后不良率及病死率明显高于低乳酸组(χ^(2)=54.692、11.790、5.926,P<0.05);低乳酸清除率组患儿的脑损伤率、预后不良率及病死率明显高于高乳酸清除率组,差异均有统计学意义(χ^(2)=71.816、15.016、6.966,P<0.01)。ROC曲线分析提示联合监测动脉血乳酸和乳酸清除率预测脑损伤能力最佳,其灵敏度为100%、特异度为98.6%。结论联合监测动脉血乳酸和乳酸清除率对早期筛查窒息新生儿脑损伤及判断预后具有一定的临床价值。

Objective To explore the value of arterial blood lactate and lactate clearance in early evaluation of brain injury in asphyxia neonates,in order to provide reference for the early identification of brain injury in neonates.Methods A total of 129 cases of neonatal asphyxia admitted to Neonatology Department,Longgang District Central Hospital of Shenzhen from May 2016 to May 2019 were retrospectively analyzed.According to whether the children had neurological symptoms or abnormal amplitude integrated electroencephalogram monitoring results,the neonates were divided into brain injury group(n=83 cases)and non-brain injury group(n=46).The differences in arterial blood pH,base excess(BE),lactate and lactate clearance between the two groups were analyzed.The rates of brain injury,poor prognosis and fatality of children were compared between children with high and low lactic acid level and lactate clearance.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of arterial blood lactic acid and lactate clearance in brain injury of asphyxia neonates.Results There were 9 deaths brain injury group,26 with poor prognosis and 48 with good prognosis among survivors.The pH and BE of arterial blood in the brain injury group were significantly lower than those in non-brain injury group within 1 hour after birth,while the lactic acid level was significantly higher than that in the non-brain injury group(t=10.159,9.023,9.917,P<0.01).The pH of arterial blood and the lactate clearance of lactic acid in the brain injury group were lower than those in the non-brain injury group at 6 hours after treatment,while the lactic acid level was higher than that in the non-brain injury group(t=4.869,9.708,9.917,P<0.05).There was no statistically significant difference in the BE value within 6 hours after treatment(t=1.732,P>0.05).The brain damage rate,poor prognosis rate and fatality rate of children in the high lactic acid group were significantly higher than those in the low lactic acid group(χ^(2)=54.692,11.790,5.926,P<0.05),which were also significantly higher in high lactate clearance group than those in low lactate clearance group(χ^(2)=71.816,15.016,6.966,P<0.05).ROC curve analysis showed that joint monitoring of arterial blood lactic acid and lactate clearance predicted brain injury ability best,with sensitivity of 100%and specificity of 98.6%.Conclusion The joint monitoring of arterial blood lactic acid and lactate clearance has certain clinical value in early screening of brain injury and prognosis judgment in asphyxia neonates.