脓毒症患儿乳酸水平与预后的相关性分析

【目的】探讨脓毒症患儿血清乳酸（lactic acid，LA）水平与其预后的关系。【方法】入住本院儿童重症监护病房（PICU）的脓毒症患365例，依据入住PICU 24 h内的血清 LA水平分为重度组（≥4 mmol/L）47例，轻度组（2 mmol/L≤LA＜4 mmol/L）108例，正常组（＜2 mmol/L）210例。分析血清 LA水平、6h乳酸清除率（lactate clearance rate，LCR）与脓毒症患儿严重程度和预后的相关性。【结果】LA重度组，轻度组及正常组并发严重脓毒症或脓毒性休克发生率分别为53．19％％、38．89％％、14．29％（P＜0．05），并发多器官功能障碍综合征发生率分别为44．68％、33．34％和13．34％（P＜0．05）。脓毒性休克组、严重脓毒症组和一般脓毒症组 LA水平分别为（4．00±3．85）mmol/L，（2．98±2．54）mmol/L，（1．85±1．52）mmol/L ，差异有统计学意义（H＝38．55，P ＝0．000）。三组患儿的6 h后 LCR分别为（8．01±0．70）％，（12．34±15．89）％，（22．28±14．46）％，差异有统计学意义，（H＝15．01，P＝0．000）。随着时间延长，入院时、入院24 h及入院48 h其 LA水平呈下降趋势，差异无显著性（P＞0．05）。生存患儿与死亡患儿入院时 LA水平分别为2．09±1．67 mmol/L，4．27±4．16 mmol/L，两组比较差异有统计学意义（u＝4424．00，P＝0．002）。低LCR组病死率明显高于高LCR组，差异有统计学意义（P＜0．05）。【结论】动态监测脓毒症乳酸变化及乳酸清除率的变化有利于掌握病情变化及判断预后。

Analysis of the Correlation Between Lactic Acid Level and Prognosis in Children with Sepsis

[Obj ective]To explore the correlation between serum lactate level and the prognosis in children with sep-sis.[Methods]According to serum lactate level in pediatric intensive care unit（PICU）within 24h,365 children with sep-sis in PICU of our hospital were divided into severely elevated group （≥4mmol/L,n=47 ）,mildly elevated group （2mmol/L≤lactate〈4mmol/L,n=108）and normal group（〈2mmol/L,n=210）.The correlation of serum lactate level and 6h-lactate clearance rate with disease severity and prognosis of pediatric patients with sepsis was analyzed.[Re-sults]The incidence of severe sepsis or septic shock in severe lactate elevation group,mild lactate elevation group and nor-mal group was 48.54%,37.23% and 14.25%（P〈0.05）respectively.The incidence multiple organ dysfunction syn-drome in 3 groups was 45.34%,32.15% and 13.67%（p〈0.05）respectively.The lactate levels in septic shock group, severe sepsis group and general sepsis group were 4.00±3.851mmol/L,2.98±2.537mmol/L and 1.85±1.523mmol/L respectively,and there was significant difference（H=38.551,P=0.000）.The 6h-lactate clearance rate of 3 groups was （8.01±0.703）%,（12.34±15.89）% and （22.28 ± 14.46）% respectively,and there was significant difference（H=15.008,P=0.000）.Lactic acid was gadually decreased at admission,admission 24 hours and 48 hours of admission,but the difference was no statistically significant （P＆gt;0.05）.Lactate level in survival group and death group on admission were 2.085±1.669mmol/L and 4.27±4.135mmol/L respectively,and there was significant difference（u=4424.00,P=0.002）.Serum lactate levels of survival children at 1,2 and 3 days had the decreasing trend,while those of death or a-bandoned children had the increasing trend（P〈0.05）.The mortality in low lactate clearance rate group was obviously higher than that in high lactate clearance rate group,and there was significant difference（P〈0.05）.[Conclusion]The dynamic monitoring of the changes of lactate and lactate clearan