中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2012年
2期
148-151
,共4页
佟玉静%佟广辉%刘春峰%许巍%李玖军%王丽杰%宋文良
佟玉靜%佟廣輝%劉春峰%許巍%李玖軍%王麗傑%宋文良
동옥정%동엄휘%류춘봉%허외%리구군%왕려걸%송문량
乳酸%乳酸清除率%脓毒性休克%预后%儿童
乳痠%乳痠清除率%膿毒性休剋%預後%兒童
유산%유산청제솔%농독성휴극%예후%인동
Lactate%Lactate clearance rate%Septic shock%Prognosis%Children
目的 评价血乳酸及乳酸清除率与脓毒性休克患儿预后的关系.方法 2009年10月至2011年6月我院PICU收治的脓毒性休克患儿42例,所有患儿均按照脓毒性休克诊疗方案进行早期目标指导治疗,测定每例患儿复苏前及复苏后1h、2h、6h血乳酸值,计算复苏后1h、2h、6h的乳酸清除率.按照预后将患儿分为存活组(n=20)和死亡组(n=22),评价早期乳酸值和乳酸清除率与预后的关系.结果 (1)存活组复苏前及复苏后1h、2h、6h的乳酸值明显低于死亡组[(3.92±2.58) mmol/Lvs (6.91 ±4.16) mmol/L,(2.79±1.89) mmol/L vs (7.93±4.39) mmol/L,(2.20±1.83) mmol/L vs(9.20±4.97) mmol/L,(1.32±0.51) mmol/L vs (9.94±5.02) mmol/L],差异具有统计学意义(P<0.05).(2)存活组复苏后1h、2h、6h的乳酸清除率明显高于死亡组[(26.31 ±20.82)% vs(-24.28±53.39)%,(43.46±17.85)% vs(-34.31±58.98)%,(61.04±16.71)% vs(-45.33±83.51)%],差异具有统计学意义(P<0.05).(3)通过受试者工作特征曲线分析,复苏后6h血乳酸值和乳酸清除率的曲线下面积分别为99.4%、96.7%;复苏后6h血乳酸>2.20 mmol/L及复苏后6h乳酸清除率<18.65%,患儿病死率高.结论 脓毒性休克患儿动态监测血乳酸具有重要意义,复苏后6h的血乳酸值及乳酸清除率可作为预后判断的指标.
目的 評價血乳痠及乳痠清除率與膿毒性休剋患兒預後的關繫.方法 2009年10月至2011年6月我院PICU收治的膿毒性休剋患兒42例,所有患兒均按照膿毒性休剋診療方案進行早期目標指導治療,測定每例患兒複囌前及複囌後1h、2h、6h血乳痠值,計算複囌後1h、2h、6h的乳痠清除率.按照預後將患兒分為存活組(n=20)和死亡組(n=22),評價早期乳痠值和乳痠清除率與預後的關繫.結果 (1)存活組複囌前及複囌後1h、2h、6h的乳痠值明顯低于死亡組[(3.92±2.58) mmol/Lvs (6.91 ±4.16) mmol/L,(2.79±1.89) mmol/L vs (7.93±4.39) mmol/L,(2.20±1.83) mmol/L vs(9.20±4.97) mmol/L,(1.32±0.51) mmol/L vs (9.94±5.02) mmol/L],差異具有統計學意義(P<0.05).(2)存活組複囌後1h、2h、6h的乳痠清除率明顯高于死亡組[(26.31 ±20.82)% vs(-24.28±53.39)%,(43.46±17.85)% vs(-34.31±58.98)%,(61.04±16.71)% vs(-45.33±83.51)%],差異具有統計學意義(P<0.05).(3)通過受試者工作特徵麯線分析,複囌後6h血乳痠值和乳痠清除率的麯線下麵積分彆為99.4%、96.7%;複囌後6h血乳痠>2.20 mmol/L及複囌後6h乳痠清除率<18.65%,患兒病死率高.結論 膿毒性休剋患兒動態鑑測血乳痠具有重要意義,複囌後6h的血乳痠值及乳痠清除率可作為預後判斷的指標.
목적 평개혈유산급유산청제솔여농독성휴극환인예후적관계.방법 2009년10월지2011년6월아원PICU수치적농독성휴극환인42례,소유환인균안조농독성휴극진료방안진행조기목표지도치료,측정매례환인복소전급복소후1h、2h、6h혈유산치,계산복소후1h、2h、6h적유산청제솔.안조예후장환인분위존활조(n=20)화사망조(n=22),평개조기유산치화유산청제솔여예후적관계.결과 (1)존활조복소전급복소후1h、2h、6h적유산치명현저우사망조[(3.92±2.58) mmol/Lvs (6.91 ±4.16) mmol/L,(2.79±1.89) mmol/L vs (7.93±4.39) mmol/L,(2.20±1.83) mmol/L vs(9.20±4.97) mmol/L,(1.32±0.51) mmol/L vs (9.94±5.02) mmol/L],차이구유통계학의의(P<0.05).(2)존활조복소후1h、2h、6h적유산청제솔명현고우사망조[(26.31 ±20.82)% vs(-24.28±53.39)%,(43.46±17.85)% vs(-34.31±58.98)%,(61.04±16.71)% vs(-45.33±83.51)%],차이구유통계학의의(P<0.05).(3)통과수시자공작특정곡선분석,복소후6h혈유산치화유산청제솔적곡선하면적분별위99.4%、96.7%;복소후6h혈유산>2.20 mmol/L급복소후6h유산청제솔<18.65%,환인병사솔고.결론 농독성휴극환인동태감측혈유산구유중요의의,복소후6h적혈유산치급유산청제솔가작위예후판단적지표.
Objective To evaluate the relationship between lactate,lactate clearance rate and prognosis of children with septic shock.Methods A total of 42 children with septic shock admitted in the PICU from Oct 2009 to Jun 2011 were enrolled in the study.All the children were given goal-directed therapy early according to the treatment routine of septic shock.The blood lactate levels before resuscitation and at 1h,2h,6 h after resuscitation were detected,the lactate clearance rates at 1 h,2 h,6 h after resuscitation were calculated.All the patients were divided into the survival group ( n =20 ) and the non-survival group ( n =22 ) by prognosis.The relationship between the early lactate level,lactate clearance rate and prognosis of the children with septic shock was evaluated.Results ( 1 ) The lactate levels before resuscitation and at 1 h,2 h,6 h after resuscitation in the survival group were significantly lower than those in the non-survival group [ (3.92 ± 2.58) mmol/L vs (6.91 ± 4.16) mmol/L,( 2.79 ± 1.89 ) mmol/L vs ( 7.93 ± 4.39 ) mmol/L,( 2.20 ±1.83) mmol/L vs (9.20 ±4.97) mmol/L,( 1.32 ±0.51 ) mmol/L vs (9.94 ±5.02) mmol/L,P <0.05].(2) The lactate clearance rates at 1 h,2 h,6 h after resuscitation in the survival group were significantly higher than those in the non-survival group [ (26.31 ± 20.82) % vs ( - 24.28 ± 53.39 ) %,(43.46 ± 17.85 ) % vs (-34.31±58.98)%,(61.04±16.71)% vs ( -45.33 ±83.51)%,P<0.05].(3) The area under curve of the lactate and the lactate clearance rate at 6 h after resuscitation were 99.4% and 96.7% according to the receiver operating characteristic curve.The children had high mortality if the lactate value > 2.20 mmol/L and lactate clearance rate < 18.65% at 6 h after resuscitation.Conclusion It is important to dynamicly monitor the lactate of the children with septic shock,the lactate and the lactate clearance rate at 6 h after resuscitation can be used to evaluate the prognosis.