６小时乳酸清除率与儿童脓毒性休克预后关系

目的：评价6 h乳酸清除率与儿童脓毒性休克的关系。方法选取2009年11月至2013年7月安徽省立儿童医院儿童重症监护室脓毒性休克患儿45例，所有患儿入院后均按照2006年中华医学会儿科学分会急救学组制定的脓毒性休克诊疗方案进行早期目标化治疗，分别测定每例患儿复苏前及复苏后6h乳酸值，并计算6h乳酸清除率。按照预后将患儿分为存活组（n＝21）和死亡组（n＝24），评价6 h乳酸清除率与预后的关系。结果存活组复苏前及复苏后6 h乳酸值明显低于死亡组（4.25 mmol／L vs 6.87 mmol／L，P＜0.05）。存活组复苏后6 h乳酸清除率高于死亡组（21.12 mmoi／L）vs（－22.56 mmol／L）（P＜0.05）。结论脓毒性休克时动态监测血乳酸变化有助于对病情的评估，而6h血乳酸清除率是评估脓毒性休克患儿疗效及预后的快捷、有效指标。

Prognosis of children with septic shock assessed by 6-hour lactate clearance rate

Objective To evaluate the relationship between 6-hour lactate clearance rate and prognosis of children with septic shock.Methods From Nov 2009 to Jul 2013,a total of 45 children with septic shock admitted in our hospital PICU were enrolled in the study.All the children were given early goal-directed therapy based on the diagnostic criteria and treatment for septic shock,established by the first-aid group of Society of Pediatrics of Chinese Medical Association in 2006.The blood lactate concentrations of all cases before resusci-tation and at 6 hours after resuscitation were tested,and then the 6-hour lactate clearance rate after resuscitation was calculated.All the chil-dren were divided into survival group (n=21)and non-survival group (n=24)according to their prognosis,and the relationship between lactate clearance rate and prognosis of children was assessed.Results The lactate concentrations before resuscitation and at 6 hours after re-suscitation in the survival group were significantly lower than those in the non-survival group (4.25 mmol/L vs 6.87 mmol/L,P<0.05). Conversely,the 6-hour lactate clearance rate in the survival group were significantly higher than that in the non-survival group (21.12 mmol/L vs -22.56 mmol/L,P<0.05 ).Conclusion It is definitely helpful to dynamically monitor the blood lactate concentration of children with septic shock for disease severity evaluation.The 6-hour lactate clearance rate could be used as a simple,practical,and effective indica-tor to assess the treatment efficacy and prognosis of patients.