CAJ | 학술논문

目的：探讨早期血乳酸清除率在危重新生儿预后评估中的作用。方法对郑州市第一人民医院NICU2011年7月~2013年5月份收治的165例危重新生儿进行回顾性分析。患儿入住NICU进行新生儿危重病例评分（NCIS）、测定动脉血乳酸水平；治疗6h后再次进行动脉血乳酸测定，计算6h血乳酸清除率。根据6h血乳酸清除率将患儿分为高乳酸清除率组（乳酸清除率≥10%）和低乳酸清除率组（乳酸清除率＜10%），比较两组间的病死率差异；按入院时乳酸水平将患儿分为乳酸轻度升高人群和乳酸明显升高人群，分别比较两组内高乳酸清除率组和低乳酸清除率组间病死率的差异。结果乳酸明显升高患儿中高乳酸清除率组病死率显著低于低乳酸清除率组；乳酸轻度升高患儿中高、低乳酸清除率组间病死率差异无统计学意义。结论早期血乳酸清除率可以作为乳酸明显增高新生儿预后判断的一个良好指标，而对于乳酸轻度增高新生儿的预后判断意义不大。
목적：탐토조기혈유산청제솔재위중신생인예후평고중적작용。방법대정주시제일인민의원NICU2011년7월~2013년5월빈수치적165례위중신생인진행회고성분석。환인입주NICU진행신생인위중병례평분（NCIS）、측정동맥혈유산수평；치료6h후재차진행동맥혈유산측정，계산6h혈유산청제솔。근거6h혈유산청제솔장환인분위고유산청제솔조（유산청제솔≥10%）화저유산청제솔조（유산청제솔＜10%），비교량조간적병사솔차이；안입원시유산수평장환인분위유산경도승고인군화유산명현승고인군，분별비교량조내고유산청제솔조화저유산청제솔조간병사솔적차이。결과유산명현승고환인중고유산청제솔조병사솔현저저우저유산청제솔조；유산경도승고환인중고、저유산청제솔조간병사솔차이무통계학의의。결론조기혈유산청제솔가이작위유산명현증고신생인예후판단적일개량호지표，이대우유산경도증고신생인적예후판단의의불대。
Objective To explore the prognostic values of early blood lactate clearance rate in neonatal with critical illness. Methods The clinic dates of 165 neonates with critical illness admitted into the newborn intensive care unit (NICU) of The Zhengzhou First People's Hospital from July 2011 to May 2013 were analyzed retrospectively. The neonatal critical illness score (NCIS), the arterial blood lactate levels before treated and 6 hours after treated were measured respectively, and then the 6h arterial blood lactate clearance rate were calculated in all infants. Using 6h arterial blood lactate clearance rate 10% as limit, the patients were divided into high lactate clearance rate group (≥10%) and low lactate clearance rate group(<10%). The mortality between the two groups was compared. According to 6h arterial blood lactate, the patients were divided into population of lactic acid mildly elevated and population of lactic acid significantly increased. In these two populations, the mortality was compared respectively with the high lactate clearance rate group and low lactate clearance rate group. Results The mortality of the high lactate clearance rate group was significantly lower compared that of the low lactate clearance rate group in the lactic acid significantly increased population. In the mildly elevated lactate population, the difference of the mortality between the high and low lactate clearance rate children was not significant. Conclusion Early blood lactate clearance rate is a valuable predictor for the population with lactic acid significantly increased, but is not for the neonates with slightly elevated lactate.