乳酸及早期乳酸清除率对窒息新生儿多器官损害的评估价值  

Evaluation Value of Lactate and Early Lactate Clearance Rate on Multiple Organ Damage in Asphyxiated Neonates

作　　者：史洁丽 刘桂芬 林森然 焦春秀 SHI Jieli;LIU Guifen;LIN Senran;JIAO Chunxiu(Department of Neonatology,Maternal and Child Health Hospital,Songjiang District,Shanghai,201600 China)

机构地区：[1]上海市松江区妇幼保健院新生儿科,上海201600

出　　处：《系统医学》2022年第10期134-137,141,共5页Systems Medicine

摘　　要：目的 分析动脉血乳酸水平和早期乳酸清除率早期评估窒息新生儿多器官损害的价值,为窒息新生儿多器官损害的早期识别提供参考。方法 回顾性分析2020年1月—2021年8月上海市松江区妇幼保健院分娩的新生儿窒息患儿172例。根据是否存在多器官损害,将患儿分为多器官损害组(n=37)和非多器官损害组(n=135),分析两组患儿动脉血pH、BE、乳酸和早期乳酸清除率的差异。分析窒息新生儿不同乳酸水平和早期乳酸清除率的多器官损害发生率、预后不良率和病死率的情况。采用受试者工作特征(ROC)曲线评价乳酸浓度及早期乳酸清除率对窒息新生儿多器官损害的预测效能。结果 多器官损害组出生后血乳酸水平明显高于非多器官损害组,差异有统计学意义(t=31.229,P<0.001);乳酸清除率低于非多器官损害组,差异有统计学意义(t=83.701,P<0.001)。以乳酸浓度9.78 mmol/L作为诊断高乳酸的最佳界值,高乳酸组多器官损害发生率明显高于低乳酸组,差异有统计学意义(χ^(2)=105.603,P<0.001)。以乳酸清除率18.0%作为低乳酸清除率最佳诊断界值,高乳酸清除率组的多器官损害发生率(3.73%)明显低于低乳清除酸率组多器官损害发生率(84.21%),差异有统计学意义(χ^(2)=113.566,P<0.001)。结论 联合监测动脉血乳酸水平和早期乳酸清除率对窒息新生儿发生多器官损害的早期判断及对多器官损害预后的评估具有一定的临床价值。Objective To analyze the value of arterial blood lactate level and early lactate clearance rate in early assessment of multiple organ damage in asphyxiated neonates,and to provide reference for early identification of multiple organ damage in asphyxiated neonates.MethodsA retrospective analysis was performed on 172 cases of neonatal asphyxia delivered to Shanghai Songjiang District Maternal and Child Health Hospital from January 2020 to August 2021.According to the presence or absence of multiple organ damage,the children were divided into multiple organ damage group(n=37) and non-multiple organ damage group(n=135).The differences in arterial blood pH,BE,lactate and early lactate clearance were analyzed between the two groups.To analyze the incidence of multiple organ damage,poor prognosis and mortality in asphyxiated neonates with different lactate levels and early lactate clearance rates.Receiver operating characteristic(ROC) curves were used to evaluate the predictive power of lactate concentration and early lactate clearance on multiple organ damage in asphyxiated neonates.ResultsThe postnatal blood lactate level in the multiple organ damage group was significantly higher than that in the non multiple organ damage group,and the difference was statistically significant(t=31.229,P<0.001).The lactate clearance rate was lower than that of the non-multiple organ damage group,and the difference was statistically significant(t=83.701,P<0.001).Taking the lactate concentration of 9.78 mmol/L as the best cut-off value for the diagnosis of high lactate,the incidence of multiple organ damage in the high lactate group was significantly higher than that in the low lactate group,and the difference was statistically significant(χ~2=105.603,P<0.001).Taking the lactate clearance rate of 18.0% as the best diagnostic threshold for low lactate clearance rate,the incidence of multi-organ damage(3.73%) of the high lactic acid removal group is significantly lower than the incidence of multi-organ damage(84.21%) and the difference w

关 键 词：乳酸 乳酸清除率 多器官损害 窒息 新生儿 

分 类 号：R722.12[医药卫生—儿科]