动脉血乳酸水平与新生儿感染性休克严重程度及预后的相关性  

Correlation between prognosis and severity of neonatal septic shock and levels of lactate in arterial blood

作　　者：赵亮[1] 朱永杰[1] 赵振江[1] Zhao Liang;Zhu Yongjie;Zhao Zhenjiang(Department of Emergency,Children’s Hospital Affiliated to Zhengzhou University,Henan Children’s Hospital,Zhengzhou Children’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院河南省儿童医院郑州儿童医院急诊科,450000

出　　处：《中国实用医刊》2019年第23期56-59,共4页Chinese Journal of Practical Medicine

摘　　要：目的探究动脉血乳酸水平与新生儿感染性休克严重程度与预后的关系。方法选取2019年1月至2019年6月郑州儿童医院收治的感染性休克新生儿30例,按照不同休克程度分为轻度休克组(n=12)、中度休克组(n=10)、重度休克组(n=8)。另选择同期出生的健康新生儿作为正常组(n=15)。根据复苏治疗后6 h的好转情况分为预后良好组(n=19)与预后不良组(n=11)。回顾性分析各组治疗后6 h的好转情况、治疗前、治疗后6 h及24 h的乳酸浓度、乳酸清除率以及治疗后24 h死亡情况。分别采用Spearman、ROC曲线分析乳酸水平与休克程度及预后的相关性。结果轻度休克组治疗后6 h好转情况优于重度休克组(P<0.05);治疗前,轻度休克组乳酸浓度低于重度休克组(P<0.05);治疗后6、24 h轻度休克组乳酸浓度低于中度及重度休克组(P<0.05)。乳酸水平与休克程度呈正相关(P<0.05)。治疗后6、24 h预后良好组乳酸浓度低于预后不良组,6、24 h乳酸清除率高于预后不良组(P<0.05)。治疗前、治疗后6、24 h乳酸水平对预测预后有较高敏感性。结论乳酸水平与新生儿感染性休克严重程度成正比,高动脉血乳酸浓度患儿死亡风险更高,动脉血乳酸水平可作为预测感染性休克患儿预后的敏感指标。Objective To investigate the diagnostic value of lactate level in arterial blood for the prognosis of neonatal septic shock.Methods Thirty newborns with septic shock admitted to Zhengzhou Children’s Hospital from January 2019 to June 2019 were selected.And they were divided into three groups according to shock degrees,mild shock group(n=12),moderate shock group(n=10),and severe shock group(n=8).The newborns were re-divided into good prognosis group(n=19)and poor prognosis group(n=11)according to the improvement after 6 hours of resuscitation treatment.The lactate level,lactate clearance rate and 24 hour mortality were analyzed retrospectively.Correlation between lactate level and shock severity,as well as the diagnostic value of lactate level for the prognosis were determined by Spearman and receiver operating characteristic curve.Results The improvement rate of mild shock group was higher than that of severe shock group 6 h after treatment(P<0.05).The level of lactate in mild shock group was lower than that in severe shock group before treatment(P<0.05).The level of lactate in mild shock group was the lowest 6 h and 12 h after treatment(P<0.05).The level of lactate was positively correlated with the degree of shock(P<0.05).At post-treatment 6 h and 12 h,the lactate level in the good prognosis group was lower than that in the poor prognosis group,and the lactate clearance rate was higher than that in the poor prognosis group(P<0.05).The lactate level pretreatment and 6 and 12 h post treatment had high sensitivity to prognostic prediction.Conclusions The lactate level in arterial blood is positively correlated with the severity of septic shock in neonates.Children with high lactate concentration suffer a higher risk of death.Therefore,lactate concentration can be used as a sensitive prognostic indicator for children with septic shock.

关 键 词：动脉血乳酸水平 新生儿感染性休克程度 预后 诊断价值 

分 类 号：R720.597[医药卫生—急诊医学]