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目的探讨动态监测PICU患儿血乳酸与小儿危重病例评分(PCIS)的相关性。方法对77例入住南通大学附属常州儿童医院儿科重症监护病房的患儿立即进行PCIS,根据评分结果分为极危重组(23例)、危重组(32例)、非危重组(22例)。并检测患儿动脉血乳酸水平,每6 h监测1次,并测出乳酸峰值。比较各组间乳酸监测指标(入PICU乳酸水平、乳酸峰值)和PCIS,进行相关性分析,探讨其与患儿预后的相关性。结果极危重组血乳酸水平:入PICU时乳酸[(5.28±3.69)mmol.L-1]、乳酸峰值[(8.54±4.32)mmol.L-1]明显高于危重组和非危重组(F=3.98,3.12,Pa<0.01),而PCIS[(65.79±2.34)分]明显低于其他2组(F=4.23,P<0.01);死亡组PCIS[(62.35±4.22)分]低于存活组[(89.21±5.36)分](t=3.15,P<0.01),而血乳酸水平[(5.31±4.05)mmol.L-1]高于存活组[(3.22±2.13)mmol.L-1](t=2.32,P<0.05);PCIS与血乳酸水平呈负相关(r=-0.889,P<0.01)。结论血乳酸升高的PICU危重患儿病情更重、预后更差,PCIS评分可有效评估患儿的病情和预后,并与乳酸水平存在显著负相关。动态监测血乳酸水平是反映危重病患儿病情严重程度和预测患儿转归的较好指标。
Objective To investigate the correlation between the dynamic monitoring of blood lactic acid and pediatric critical illness score (PCIS) in PICU children. Methods A total of 77 children admitted to the Pediatric Intensive Care Unit of Changzhou Children’s Hospital affiliated to Nantong University were enrolled in this study. They were divided into two groups: critically ill patients (23 patients), critically ill patients (32 patients) and non-critically ill patients (22 patients). And detection of arterial blood lactate levels in children, monitoring once every 6 h, and measured lactic acid peak. Lactic acid monitoring indicators (such as lactate level, lactate peak) and PCIS were compared between groups to find out the correlation between them and prognosis. Results Serum levels of lactic acid in critically ill patients: [(5.28 ± 3.69) mmol.L-1] and lactate peak [(8.54 ± 4.32) mmol.L-1] were significantly higher in PICU than those in critically ill patients and non-critically ill patients = 3.98, 3.12, Pa <0.01), while PCIS [(65.79 ± 2.34)] was significantly lower than the other two groups (F = 4.23, P <0.01); PCIS in the death group (62.35 ± 4.22) (5.32 ± 5.35) mmol.L-1 [(3.22 ± 2.13) mmol.L-1] in the survival group [(89.21 ± 5.36) ] (t = 2.32, P <0.05). PCIS was negatively correlated with blood lactate level (r = -0.889, P <0.01). Conclusion The critically ill children with PICL are more serious and their prognosis is worse. The PCIS score can effectively evaluate the condition and prognosis of children with significant negative correlation with the level of lactate. Dynamic monitoring of blood lactate level is a good indicator to reflect the severity of illness in critically ill children and prognosis of children.