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目的:探讨早期动态监测血乳酸浓度对评价小儿脓毒性休克病情严重程度与预后的价值。方法:入选90例小儿脓毒性休克患儿,以诊断休克为研究起点,动态监测研究0 h、6 h的血乳酸,计算6 h乳酸清除率。按PCIS评分分为≥70分组(n=41)、60~70分组(n=40)、<60分组(n=9);按预后分为存活组(n=62)与死亡组(n=28);按乳酸清除率分为高乳酸清除率组(n=57)与低乳酸清除率组(n=33),对各组PCIS评分、0 h血乳酸及乳酸清除率等指标进行比较。结果:≥70分组、60~70分组、<60分组0 h血乳酸及乳酸清除率比较差异有计学意义(P<0.05),≥70分组明显低于60~70分组及<60分组,60~70分组明显低于<60分组(P均<0.05);存活组PCIS评分及乳酸清除率显著高于死亡组,0 h血乳酸水平明显低于死亡组(P<0.05);高乳酸清除率组PCIS评分显著高于低乳酸清除率组。PCIS评分与0 h血乳酸浓度呈显著负相关(r=-0.619,P<0.05),与乳酸清除率呈显著正相关(r=-0.702,P<0.05)。结论:在评价小儿脓毒性休克的病情严重程度及预后方面,早期血乳酸清除率比单次血乳酸浓度更有意义。
Objective: To investigate the value of early dynamic monitoring of serum lactate levels in evaluating the severity and prognosis of pediatric septic shock. Methods: Ninety children with septic shock were enrolled in this study. Based on the diagnosis of shock, the lactic acid of 0 h and 6 h was dynamically monitored and the lactic acid clearance of 6 h was calculated. The patients were divided into survival group (n = 62) and death group (n = 62) according to the score of PCIS, 28). The lactic acid clearance rate was divided into high lactic acid clearance group (n = 57) and low lactic acid clearance group (n = 33). The PCIS score, 0 h lactic acid and lactic acid clearance rate of each group were compared. Results: There were significant differences in the clearance rate of lactic acid and lactic acid between 0 ~ 70 group and 60 ~ 70 group, <60 group at 0 h (P <0.05), the score of ≥70 group was significantly lower than 60 ~ 70 group and <60 group (P <0.05). The PCIS score and lactic acid clearance rate in survival group were significantly higher than those in death group, and the level of serum lactate at 0 h was significantly lower than that of death group (P <0.05) Group PCIS score was significantly higher than low lactate clearance group. There was a significant negative correlation between PCIS score and 0 h lactic acid concentration (r = -0.619, P <0.05), and significant positive correlation with lactic acid clearance rate (r = -0.702, P <0.05). CONCLUSIONS: Early blood lactate clearance rates are more meaningful than single blood lactate concentrations in assessing the severity and prognosis of septic shock in children.