中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
Chinese Pediatric Emergency Medicine
2015年
11期
780-782,786
,共4页
朱荣平%李晓英%顾春燕%郑倩
硃榮平%李曉英%顧春燕%鄭倩
주영평%리효영%고춘연%정천
婴儿,新生%乳酸%乳酸清除率%重度窒息%预后
嬰兒,新生%乳痠%乳痠清除率%重度窒息%預後
영인,신생%유산%유산청제솔%중도질식%예후
Infant,newborn%Lactate%Lactate clearance rate%Severe asphyxia%Prognosis
目的 探讨动脉血乳酸水平及乳酸清除率在评估新生儿重度窒息预后中的价值.方法 选择2011年1月至2014年10月我院NICU收治的115例重度窒息新生儿,根据预后结果分为死亡组27例,存活组88例;分别统计两组患儿不同时间点的乳酸和乳酸清除率值,并对乳酸、乳酸清除率与预后进行相关性分析,绘制受试者工作特征(ROC)曲线,评价不同时间点乳酸和乳酸清除率对预后的预测价值.结果 死亡组和存活组患儿初始乳酸水平和新生儿危重病例评分比较差异无统计学意义(P＞0.05),1h、2h、6h乳酸及乳酸清除率比较,差异均有统计学意义(P＜0.05).低乳酸清除率组多脏器功能障碍综合征发生率及病死率均高于高乳酸清除率组(44.64％ vs.15.25％,P=0.001;32.14％ vs.15.25％,P=0.033).治疗后各时间点乳酸水平与预后呈正相关,1h、2h、6h的乳酸清除率与预后呈负相关.治疗后各个时点乳酸预测预后的ROC曲线下面积分别为0.625、0.719、0.835,乳酸清除率曲线下面积分别为0.676、0.784、0.898.结论 重度窒息患儿乳酸清除率低提示预后不良,抢救后6h动脉血乳酸水平及乳酸清除率是预测重度窒息预后的指标.
目的 探討動脈血乳痠水平及乳痠清除率在評估新生兒重度窒息預後中的價值.方法 選擇2011年1月至2014年10月我院NICU收治的115例重度窒息新生兒,根據預後結果分為死亡組27例,存活組88例;分彆統計兩組患兒不同時間點的乳痠和乳痠清除率值,併對乳痠、乳痠清除率與預後進行相關性分析,繪製受試者工作特徵(ROC)麯線,評價不同時間點乳痠和乳痠清除率對預後的預測價值.結果 死亡組和存活組患兒初始乳痠水平和新生兒危重病例評分比較差異無統計學意義(P＞0.05),1h、2h、6h乳痠及乳痠清除率比較,差異均有統計學意義(P＜0.05).低乳痠清除率組多髒器功能障礙綜閤徵髮生率及病死率均高于高乳痠清除率組(44.64％ vs.15.25％,P=0.001;32.14％ vs.15.25％,P=0.033).治療後各時間點乳痠水平與預後呈正相關,1h、2h、6h的乳痠清除率與預後呈負相關.治療後各箇時點乳痠預測預後的ROC麯線下麵積分彆為0.625、0.719、0.835,乳痠清除率麯線下麵積分彆為0.676、0.784、0.898.結論 重度窒息患兒乳痠清除率低提示預後不良,搶救後6h動脈血乳痠水平及乳痠清除率是預測重度窒息預後的指標.
목적 탐토동맥혈유산수평급유산청제솔재평고신생인중도질식예후중적개치.방법 선택2011년1월지2014년10월아원NICU수치적115례중도질식신생인,근거예후결과분위사망조27례,존활조88례;분별통계량조환인불동시간점적유산화유산청제솔치,병대유산、유산청제솔여예후진행상관성분석,회제수시자공작특정(ROC)곡선,평개불동시간점유산화유산청제솔대예후적예측개치.결과 사망조화존활조환인초시유산수평화신생인위중병례평분비교차이무통계학의의(P＞0.05),1h、2h、6h유산급유산청제솔비교,차이균유통계학의의(P＜0.05).저유산청제솔조다장기공능장애종합정발생솔급병사솔균고우고유산청제솔조(44.64％ vs.15.25％,P=0.001;32.14％ vs.15.25％,P=0.033).치료후각시간점유산수평여예후정정상관,1h、2h、6h적유산청제솔여예후정부상관.치료후각개시점유산예측예후적ROC곡선하면적분별위0.625、0.719、0.835,유산청제솔곡선하면적분별위0.676、0.784、0.898.결론 중도질식환인유산청제솔저제시예후불량,창구후6h동맥혈유산수평급유산청제솔시예측중도질식예후적지표.
Objective To investigate the prognostic value of arterial blood lactate(Lac) and lactate clearance rate(LCR) for severe neonatal asphyxia.Methods One hundred and fifteen cases of severe neo natal asphyxia admitted in NICU of our hospital from January 2011 to October 2014 were retrospectively analyzed.Lac and LCR values were measured at multiple time points and were compared between those died (27 cases,the death group) and those survived (88 cases, the survival group).The correlation between prognosis and Lac as well asLCR was investigated.Receiver operating characteristic(ROC) curves were drawn to evaluate the prognostic value of Lac and LCR at different time points.Results No significant differences in initial lactate levels and neonatal critical illness score (NCIS) were detected between the two groups (P ＞0.05), while Lac and LCR values at 1 h,2 h,and 6 h showed significant differences between the two groups (P ＜ 0.05).The low-LCR group showed a higher rate of multiple organ dysfunction syndrome and mortality rates than the high-LCR group (44.64％ vs.15.25 ％, P =0.001;32.14％ vs.15.25 ％, P =0.033, respectively).Post-treatment Lac level was positively correlated with prognosis, while LCR at 1 h,2 h, and 6 h were negatively correlated with prognosis.Areas under curve of Lac ROC at 1 h,2 h, and 6 h were 0.625,0.719,and 0.835 respectively, while areas under curve of LCR ROC at 1 h, 2 h, and 6 h were 0.676,0.784, and 0.898 respectively.Conclusion Low LCR for severe neonatal asphyxia predicts poor prognosis.Lac level and LCR at 6 h after emergency treatment is a prognostic indicator for severe neonatal asphyxia.
