动脉血乳酸联合肺泡-动脉血氧分压差水平对脓毒症儿童早期病情判断及预后评估的价值  

Value of arterial lactate combined with alveolar-arterial oxygen pressure difference in early diagnosis and prognosis of sepsis in children

作　　者：徐旭东 刘杨[1] 古恩琼 林创杰 林明祥[1] XU Xudong;LIU Yang;GU Enqiong;LIN Chuangjie;LIN Mingxiang(Department of Pediatrics,Shantou Central Hospital,Guangdong Shantou 515000,China)

机构地区：[1]汕头市中心医院儿科,广东汕头515000

出　　处：《中国妇幼健康研究》2023年第6期53-62,共10页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨动脉血乳酸(LAC)联合肺泡—动脉血氧分压差(PA-aDO_(2))水平对脓毒症儿童早期病情判断及预后评估的价值。方法回顾性选取2019年10月至2021年1月于汕头市中心医院就诊的脓毒症儿童153例,根据病情严重程度将其分为非危重组(n=89)和危重组(n=64);另选取同期于我院健康体检的73例儿童作为对照组。比较三组儿童的临床资料与实验室指标,分析LAC和PA-aDO_(2)与各相关指标之间的关系。根据脓毒症患儿的预后情况将其分为死亡组(n=52)和存活组(n=101),采用Logistic回归分析脓毒症患儿死亡的影响因素,并通过曲线拟合和阈值效应分析确定LAC和PA-aDO_(2)水平的阈值效应;通过受试者工作特征(ROC)曲线分析二者及联合指标对脓毒症患儿死亡的预测效能。基于Logistic回归分析的影响因素建立脓毒症患儿死亡的列线图预测模型并予以验证评价。结果脓毒症患儿的LAC和PA-aDO_(2)水平显著高于对照组儿童,且随着病情的加重而升高(P<0.05)。患儿的LAC水平与PA-aDO_(2)呈正相关,且二者均与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、降钙素原(PCT)呈显著正相关(P<0.05),与小儿危重病例评分(PCIS)和氧合指数(OI)呈显著负相关(P<0.05)。LAC、PA-aDO_(2)、PCT及APACHEⅡ评分为脓毒症患儿死亡的独立危险因素(OR值分别为1.157、1.169、1.066、1.152,P<0.05),而乳酸清除率(LCR)为保护因素(OR=0.596,P<0.05)。曲线拟合发现随着LAC和PA-aDO_(2)水平的升高,患儿的死亡概率呈上升趋势。LAC联合PA-aDO_(2)预测脓毒症患儿预后的曲线下面积(AUC)为0.803,预测价值显著高于LAC和PA-aDO_(2)单独预测(P<0.05)。基于前述影响因素构建脓毒症患儿死亡的Nomogram预测模型,经验证评价,模型的区分度、准确性及有效性均较好。结论LAC和PA-aDO_(2)水平可有效反映脓毒症患儿的病情严重程度,均为脓毒症患儿死亡的危险因素,二者联合检Objective To investigate the value of arterial lactate(LAC)combined with alveolar-arterial oxygen pressure difference PA-aDO,in early diagnosis and prognosis of sepsis in children.Methods 153 children with sepsis who were hospitalized in our hospital from October 2019 to January 2021 were retrospectively selected,and divided into the non-critical group(n=89)and the critical group(n=64)according to the severity of the disease.In addition,73 children who underwent physical examination in our hospital during the same period were selected as the control group.The clinical data and laboratory indexes of three groups of children were compared,and the relationship between LAC,PA-aDOz and relevant indexes was analyzed.According to the prognosis of children with sepsis,they were divided into the death group(n=52)and the survival group(n=101).Logistic regression was used to analyze the influencing factors of death in children with sepsis,and the threshold effects of LAC and PA-aDOz were determined by curve fitting and threshold effect analysis.The predictive efficacy of the two and their combined indicators in the death of children with sepsis was analyzed by the receiver operating characteristic(ROC)curve.Based on the influencing factors of logistic regression analysis,the Nomogram prediction model of death in children with sepsis was established and validated.Results The levels of LAC and PA-aDO,in children with sepsis were significantly higher than those in the control group,and increased with the aggravation of the disease(P<0.05).The level of LAC in children was positively correlated with PA-aDO2,and both of them were significantly positively correlated with the Acute Physiology and Chronic Health Evaluation I(APACHE I)score,the Sequential Organ-Failure Assessment(SOFA)score,and procalcitonin(PCT)(P<0.05),and were significantly negatively correlated with pediatric critical illness score(PCIS)and oxygenation index(OI)(P<0.05).LAC,PA-aDOz,PCT and APACHE II scores were independent risk factors for the death of children w

关 键 词：脓毒症 动脉血乳酸 肺泡-动脉血氧分压差 预后 影响因素 

分 类 号：R179[医药卫生—妇幼卫生保健]