动态监测血乳酸与小儿危重病例评分的相关性

目的 探讨动态监测PICU患儿血乳酸与小儿危重病例评分(PCIS)的相关性.方法 对77例入住南通大学附属常州儿童医院儿科重症监护病房的患儿立即进行PCIS,根据评分结果分为极危重组(23例)、危重组(32例)、非危重组(22例).并检测患儿动脉血乳酸水平,每6 h监测1次,并测出乳酸峰值.比较各组间乳酸监测指标(入PICU乳酸水平、乳酸峰值)和PCIS,进行相关性分析,探讨其与患儿预后的相关性.结果 极危重组血乳酸水平:入PICU时乳酸(5.28±3.69) mmol·L-1]、乳酸峰值(8.54±4.32) mmol·L-1]明显高于危重组和非危重组(F=3.98,3.12,Pa<0.01),而PCIS(65.79±2.34) 分]明显低于其他2组(F=4.23,P<0.01);死亡组 PCIS(62.35±4.22) 分]低于存活组(89.21±5.36) 分](t=3.15,P<0.01),而血乳酸水平(5.31±4.05) mmol·L-1]高于存活组(3.22±2.13) mmol·L-1](t=2.32,P<0.05);PCIS与血乳酸水平呈负相关(r=-0.889,P<0.01).结论 血乳酸升高的PICU危重患儿病情更重、预后更差,PCIS评分可有效评估患儿的病情和预后,并与乳酸水平存在显著负相关.动态监测血乳酸水平是反映危重病患儿病情严重程度和预测患儿转归的较好指标.

Correlation between Dynamic Lactic Acid Monitoring Indexes and Pediatric Critical Illness Score

Objective To explore the relationship between dynamic lactic acid monitoring indexes and its pediatric critical illness score(PCIS) and clinical significance. Methods PCIS of 77 critically ill children,who were admitted into pediatric intensive care unit(PICU) in Changzhou Children′s Hospital Affiliated to Nantong University were recorded after hospitalization.According to the scores of PCIS,all the children were divided into extremely critical group(n=23),critical group(n=32),non-critical group(n=22).Blood concentration of lactic acid were detected every 6 hours.Differences in their lactic acid indexes(including lactic acid level after admission to PICU,peak lactic acid level)and scores were compared,their correlation and prognosis of critically ill children were analyzed. Results Lactic acid level after admission to PICU (5.28±3.69) mmol·L-1] and peak lactic acid level (8.54±4.32) mmol·L-1]in extremely critical group were significantly higher than those in critically ill group and non-critical group(F=3.98,3.12,Pa<0.01),but PCIS (65.79±2.34) scores] were significantly lower than those in the other 2 groups(F=4.23,P<0.01).Lactic acid level of death group(5.31±4.05) mmol·L-1] were significantly higher than that in survival group(3.22±2.13) mmol·L-1](t=2.32,P<0.05).PCIS in death group (62.35±4.22) scores]were significantly lower than that in survival group(89.21±5.36) scores](t=3.15,P<0.01).PCIS was negative correlated with lactic acid indexes(r=-0.889,P<0.01). Conclusions Critically ill children with elevated lactic acid indexes are worse and poorer prognosis.PCIS score can effectively evaluate children′s condition and prognosis,and compared with lactic acid level linear correlation is existed.Dynamic lactic acid monitoring indexes is the good factor for the severe degree and predicting the prognosis of the critically ill children.