早期乳酸测定联合儿童危重病例评分在重症监护室脓毒症患儿预后评估中的作用  

The performance of early lactic acid measurement combined with Pediatric Critical Illness Score in evaluating the prognosis of children with sepsis in pediatric intensive care units

作　　者：钟娩玲 黄宇戈 Zhong Mianling;Huang Yuge(Children′s Medical Center, the Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Pro-vince, China)

机构地区：[1]广东医科大学附属医院儿童医学中心,广东湛江524001

出　　处：《中华实用儿科临床杂志》2019年第12期934-937,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨早期乳酸测定联合儿童危重病例评分(PCIS)在儿童重症监护室(PICU)脓毒症患儿预后评估中的作用。方法回顾性分析2016年6月至2018年6月广东医科大学附属医院PICU 516例脓毒症患儿的临床资料,根据入院后28 d结局将患儿分为存活组和死亡组。记录2组患儿入PICU后24 h内PCIS评分相关生理学参数并评分;绘制受试者工作特征曲线(ROC曲线),采用ROC曲线下面积(AUC)评价早期乳酸测定联合PCIS评分在PICU脓毒症患儿预后评估中的作用。结果516例脓毒症患儿中,普通脓毒症患儿238例(46.1%),严重脓毒症患儿262例(50.8%),脓毒性休克患儿16例(3.1%);存活组488例(占94.6%),死亡组28例(占5.4%)。死亡组乳酸值[2.8(1.1,10.3) mmol/L]明显高于存活组[1.2(0.8,1.9) mmol/L],PCIS评分[86(82,88)分]明显低于存活组[92(86,96)分],差异均有统计学意义(Z=9 953.5、3 259.5,均P<0.05)。ROC曲线分析显示,乳酸值、PCIS评分及乳酸值联合PCIS评分评估PICU脓毒症患儿预后的AUC分别为0.728、0.761、0.829(Z=3.744、6.127、7.759,均P<0.05)。早期乳酸测定联合PCIS评分与早期乳酸监测值、PCIS评分间AUC比较,差异有统计学意义(Z=2.114、2.122,均P<0.05);早期乳酸监测值与PCIS间AUC比较,差异无统计学意义(Z=0.480,P>0.05)。结论早期乳酸监测及PCIS评分均能预测PICU脓毒症患儿的预后,但二者联合效果更佳。Objective To explore the performance of early lactic acid measurement combined with Pediatric Critical Illness Score (PCIS) in evaluating the prognosis of children with sepsis in the Pediatric Intensive Care Unit (PICU). Methods The data of 516 pediatric patients in PICU of the Affiliated Hospital of Guangdong Medical University from June 2016 to June 2018, diagnosed as sepsis were retrospectively analyzed.The patients were divided into survival group and non-survival group according to the clinical outcome of 28 days after admission.The variables of PCIS were collected and scored.Receiver operating characteristic curve (ROC curve) was drawn, and the efficiency of the early lactic acid measurement combined with PCIS for predicting death was evaluated by using the area under ROC curve (AUC). Results Of 516 pediatric patients with sepsis, 238 cases (46.1%) were common sepsis, 262 cases (50.8%) were severe sepsis, and 16 cases (3.1%) were septic shock.Among them, 488 cases (94.6%) were pe-diatric patients survived, while 28 cases (5.4%) did not survive during hospitalization.PCIS in non-survival group [86(82, 88) scores]was significantly lower than that of survival group [92(86, 96) scores]and the early lactic acid measurement was significantly increased[2.8(1.1, 10.3) mmol/L vs.1.2(0.8, 1.9) mmol/L](Z=3 259.5, 9 953.5, all P<0.05). ROC curve analysis showed that the AUCs of early lactic acid measurement, PCIS, early lactic acid measurement combined with PCIS for predicting prognosis of pediatric patients with sepsis in the PICU were 0.728, 0.761 and 0.829, respectively (Z=3.744, 6.127, 7.759, all P<0.05). There was significant difference in the AUC between the early lactic acid measurement combined with PCIS and early lactic acid measurement, PCIS(Z=2.114, 2.122, all P<0.05). There was no significant difference in the AUC between the early lactic acid measurement and PCIS(Z=0.480, P>0.05). Conclusions The early lactic acid measurement and PCIS are effective and able to assess the prognosis of pediatric patients wit

关 键 词：乳酸 儿童危重病例评分 脓毒症 预后 儿童 

分 类 号：R720.597[医药卫生—急诊医学]