胃液pH值监测对危重症儿童发生应激性溃疡出血的早期预测价值  

Early predictive value of gastric pH monitoring for the development of stress ulcer bleeding in critically ill children

作　　者：李彩芳 冯庆红 吴昊 何开铮 LI Caifang;FENG Qinghong;WU Hao;HE Kaizheng(Department of Pediatrics,Liuzhou Materntity and Child Healthcare Hospital,Guangxi Zhuang Autonomous Region,Liuzhou,545001,China;Intensive Care Unit,Liuzhou Materntity and Child Healthcare Hospital,Guangxi Zhuang Autonomous Region,Liuzhou,545001,China)

机构地区：[1]广西壮族自治区柳州市妇幼保健院儿科,广西柳州545001 [2]广西壮族自治区柳州市妇幼保健院重症医学科,广西柳州545001

出　　处：《中国当代医药》2023年第24期77-80,共4页China Modern Medicine

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170476)。

摘　　要：目的探讨胃液pH值监测对危重症儿童发生应激性溃疡出血的早期预测价值。方法选取2018年6月至2022年10月柳州市妇幼保健院儿童重症监护病房(PICU)收治的182例入院后需留置胃管的患儿为研究对象,动态监测上述患儿胃液pH值,同时观察胃液颜色、大便情况,定期行胃液、粪便潜血试验。根据相关结果分为非应激性溃疡出血组和应激性溃疡出血组。采用多因素logistic回归分析评估在校正混杂因素后胃液pH值与应激性溃疡出血的关系,采用ROC曲线评价胃液pH值对危重症儿童应激性溃疡出血的早期预测价值。结果共纳入危重症儿童182例,其中27例(14.835%)出现应激性溃疡出血。两组患儿危重评分、胃液pH值比较,差异有统计学意义(P<0.05)。logistic回归分析显示,在校正年龄、危重评分、凝血功能障碍后,低胃液pH值是应激性溃疡出血的独立危险因素(OR=0.377,95%CI:0.242~0.585,P<0.001),预测危重症儿童发生应激性溃疡出血的AUC为0.843(95%CI:0.761~0.925,P<0.001),最佳临界值为4.5时,其敏感度、特异度分别为70%和83%。结论胃液pH值是危重症患儿应激性溃疡出血的独立预测指标,具有早期预测价值。Objective To explore the early predictive value of gastric pH in stress ulcer bleeding in critically ill children.Methods The children admitted to Pediatric Intensive Care Unit(PICU)of Liuzhou Materntity and Child Healthcare Hospital from June 2018 to October 2022 receieved gastric tube were selected as the research objects.The pH value of gastric juice of the children was dynamically monitored,the color of gastric juice and stool were observed,and gastric juice and fecal occult blood test were conducted regularly.According to the relevant results,they were divided into non stress ulcer bleeding group and stress ulcer bleeding group.Multivariate logistic regression analysis was used to evaluate the relationship between gastric juice pH and stress ulcer bleeding after correcting for confounding factors,and receiver operating characteristic curve was used to evaluate the early predictive value of gastric juice pH on stress ulcer bleeding in critically ill children.Results A total of 182 critically ill children were included,27 of whom(14.835%)had stress ulcer bleeding.There were statistically significant differences in the critical illness score and gastric juice pH between the two groups of children(P<0.05).Logistic regression analysis showed that after adjusting for age,critical score and coagulation dysfunction,low gastric juice pH was independent risk factor for stress ulcer bleeding(OR=0.377,95%CI:0.242-0.585,P<0.001).The AUC predicting stress ulcer bleeding in critical children was 0.843(95%CI:0.761-0.925,P<0.001).When the optimal critical value was 4.5,its sensitivity and specificity were 70%and 83%,respectively.Conclusion Gastric pH is an independent predictor of stress ulcer bleeding in critically ill children and has early predictive value.

关 键 词：危重症 儿童 胃酸 应激性溃疡 

分 类 号：R459.7[医药卫生—急诊医学]