血乳酸和乳酸清除率评估脓毒性休克患儿预后的临床分析  

Prognosis of children with septic shock assessed by lactate and lactate clearance rate

作　　者：佟玉静[1] 佟广辉[2] 刘春峰[1] 许巍[1] 李玖军[1] 王丽杰[1] 宋文良[1] 

机构地区：[1]中国医科大学附属盛京医院PICU,沈阳110004 [2]中国医科大学附属盛京医院检验科

出　　处：《中国小儿急救医学》2012年第2期148-151,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的 评价血乳酸及乳酸清除率与脓毒性休克患儿预后的关系。方法2009年10月至2011年6月我院PICU收治的脓毒性休克患儿42例，所有患儿均按照脓毒性休克诊疗方案进行早期目标指导治疗，测定每例患儿复苏前及复苏后1h、2h、6h血乳酸值，计算复苏后1h、2h、6h的乳酸清除率。按照预后将患儿分为存活组（n=20）和死亡组（n=22），评价早期乳酸值和乳酸清除率与预后的关系。结果（1）存活组复苏前及复苏后1h、2h、6h的乳酸值明显低于死亡组[（3．92±2．58）mmol／LVS（6．91±4．16）mmol／L，（2．79±1．89）mmol／LVS（7．93±4．39）mmol／L，（2．20±1．83）mmol／LVS（9．20±4．97）mmol／L，（1．32±0．51）mmoL／LVS（9．94±5．02）mmol／L]，差异具有统计学意义（P〈0．05）。（2）存活组复苏后1h,2h、6h的乳酸清除率明显高于死亡组[（26．31±20．82）％VS（-24．28±53．39）％，（43．46±17．85）％VS（-34．31±58．98）％，（61．04±16．71）％VS（-45．33±83．51）％]，差异具有统计学意义（P〈0．05）。（3）通过受试者工作特征曲线分析，复苏后6h血乳酸值和乳酸清除率的曲线下面积分别为99．4％、96．7％；复苏后6h血乳酸〉2．20mmol／L及复苏后6h乳酸清除率〈18．65％，患儿病死率高。结论脓毒性休克患儿动态监测血乳酸具有重要意义，复苏后6h的血乳酸值及乳酸清除率可作为预后判断的指标。Objective To evaluate the relationship between lactate,lactate clearance rate and prognosis of children with septic shock. Methods A total of 42 children with septic shock admitted in the PICU from Oct 2009 to Jun 2011 were enrolled in the study. All the children were given goalirected therapy early according to the treatment routine of septic shock. The blood lactate levels before resuscitation and at 1 h ,2 h, 6 h after resuscitation were detected,the lactate clearance rates at 1 h,2 h,6 h after resuscitation were calculated. All the patients were divided into the survival group （ n = 20） and the non-survival group （ n = 22 ） by prognosis. The relationship between the early lactate level, lactate clearance rate and prognosis of the children with septic shock was evaluated. Results （ 1 ） The lactate levels before resuscitation and at 1 h,2 h,6 h after resuscitation in the survival group were significantly lower than those in the non-survival group [ （3.92 ± 2.58） mmol/L vs （6.91±4. 16） mmol/L, （2.79 ±1.89） mmol/L vs （7.93 ±4.39） mmol/L, （2.20 ±1.83 ） rnmol/L vs （ 9. 20 ±4. 97 ） mmol/L, （ 1.32 ± 0. 51 ） mmol/L vs （ 9. 94 ± 5.02 ） mmoL/L, P 〈 0. 05 ± （2） The lactate clearance rates at 1 h,2 h,6 h after resuscitation in the survival group were significantly higher than those in the non-survival group [ （26. 31 ± 20. 82） % vs （ - 24. 28 ± 53.39 ） %, （43.46 ± 17. 85 ） % vs （-34.31±58.98）%,（61.04 ±16.71）% vs （ -45.33 ±83.51）%,P〈0.05]. （3） The area under curve of the lactate and the lactate clearance rate at 6 h after resuscitation were 99. 4% and 96. 7% according to the receiver operating characteristic curve. The children had high mortality if the lactate value 〉 2. 20 mmoL/L and lactate clearance rate 〈 18.65 % at 6 h after resuscitation. Conclusion It is important to dynamicly monitor the lactate of the children with septic shock, the lactate and the lactate clearance rate at 6 h after resuscitation can be used to eva

关 键 词：乳酸 乳酸清除率 脓毒性休克 预后 儿童 

分 类 号：R459.7[医药卫生—急诊医学]