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目的:探讨动脉血乳酸及乳酸清除率动态监测在重症脓毒症患儿预后的临床关系。方法:对收治的重症脓毒症患儿42例入院后均按重症脓毒症的诊断指南中的诊疗方案进行治疗,测定每例患儿复苏前及复苏后动脉血乳酸值,并且计算复苏后1、2、6 h的乳酸清除率。根据预后分为存活组20例与死亡组22例,评价早期乳酸和乳酸清除率与预后的关系。结果:存活组复苏前及复苏后1、2、6 h的乳酸值明显低于死亡组,差异有统计学意义(P<0.05)。存活组复苏后1、2、6 h的乳酸清除率明显高于死亡组,差异有统计学意义(P<0.05)。结论 :动态监测动脉血乳酸及乳酸清除率是判断重症脓毒症患儿预后和病情严重程度的一个良好指标,动脉血乳酸越高病情越重,预后越差;血乳酸清除率越低病情越重,预后越差。
Objective: To investigate the clinical relationship between the dynamic monitoring of arterial blood lactate and lactic acid clearance in children with severe sepsis. Methods: Forty-two children with severe sepsis admitted to our hospital were treated according to the diagnostic criteria of severe sepsis after admission. The arterial blood lactic acid levels before and after resuscitation in each child were measured. After the resuscitation, 1,2,6 h lactic acid clearance. According to the prognosis, it was divided into survival group (n = 20) and death group (n = 22). The relationship between early lactic acid and lactic acid clearance rate and prognosis was evaluated. Results: The lactic acid value of survival group before resuscitation and 1,2,6 h after resuscitation was significantly lower than that of death group (P <0.05). The survival rate of lactic acid in 1,2,6 h after resuscitation in survival group was significantly higher than that in death group, the difference was statistically significant (P <0.05). Conclusion: Dynamic monitoring of arterial blood lactic acid and lactic acid clearance rate is a good indicator to judge the prognosis and severity of severe sepsis. The higher the arterial blood lactic acid is, the worse the prognosis is. The lower the blood lactate clearance rate is Weight, the worse the prognosis.