目的 探讨脓毒症患儿血乳酸水平对病情严重程度和预后的评价作用。方法 收集脓毒症患儿484例,其中普通脓毒症组310例、严重脓毒症组105例、脓毒症休克组69例,治疗前测动脉血乳酸值,对乳酸>2 mmol/L的脓毒症休克患儿,收集其早期液体复苏后血乳酸复查值。结果 随脓毒症严重程度增加,血乳酸值逐渐增加。ROC曲线分析发现,区别脓毒症休克和非脓毒症休克的血乳酸值为2.25 mmol/L时,其诊断灵敏度为82.6%,特异性为79.8%。乳酸≤1 mmol/L、乳酸~2 mmol/L、乳酸~4 mmol/L和乳酸>4 mmol/L患儿的病死率分别为8.5%、9.4%、27.2%、67.6%,乳酸>4 mmol/L的死亡风险为乳酸≤1 mmol/L的22.4倍。治疗前血乳酸>2 mmol/L的脓毒症休克患儿复苏后血乳酸水平≤2 mmol/L和>2 mmol/L的病死率分别为33.3%、69.2%。结论 血乳酸可作为脓毒症患儿病情严重程度及预后的评价指标,血乳酸值2.25 mmol/L对脓毒症休克具有较高的诊断价值;早期复苏使血乳酸水平恢复至正常可改善脓毒症休克患儿的预后。
Abstract
Objective To investigate the value of blood lactic acid (BLA) in evaluating disease severity and prognosis in children with sepsis. Methods A total of 484 children with sepsis were enrolled and divided into common sepsis group (n = 310), severe sepsis group (n = 105), and septic shock group (n = 69). BLA level was measured before treatment, and the results of BLA re-examination after early fluid resuscitation were collected for children with septic shock and a BLA level of >2 mmol/L. Results The BLA level increased with the increasing severity of sepsis. The analysis of the receiver operating characteristic curve showed that the cut-off value of BLA for the diagnosis of septic shock was 2.25 mmol/L, with a sensitivity of 82.6% and a specificity of 79.8%. The fatality rates in the BLA ≤1 mmol/L, BLA 1.1-2 mmol/L, BLA 2.1-4 mmol/L, and BLA >4 mmol/L groups were 8.5%, 9.4%, 27.2%, and 67.6%, respectively, and the risk of death in the BLA >4 mmol/L group was 22.4 times that in the BLA ≤1 mmol/L group. In children with septic shock who had a BLA level of >2 mmol/L before treatment and whose BLA levels were ≤2 mmol/L or >2 mmol/L
after resuscitation, the fatality rates were 33.3% and 69.2%, respectively. Conclusions BLA can be used to evaluate disease severity and prognosis in children with sepsis, and a BLA level of 2.25 mmol/L has a high value in diagnosing septic shock. Early resuscitation helps BLA level return to normal and can improve the prognosis of children with septic shock.
关键词
动脉血乳酸 /
脓毒症 /
预后 /
儿童
Key words
Arterial blood lactate /
Sepsis /
Prognosis /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 张永利, 李素玮. 脓毒症微循环障碍机制的研究进展[J]. 中华医学杂志, 2015, 95(43): 3554-3556.
[2] Krau SD. Making sense of multiple organ dysfunction syndrome[J]. Crit Care Nurs Clin North Am, 2007, 19(1): 87-97.
[3] Chen YC, Jenq CC, Tian YC, et al. Rifle classification for predicting in-hospital mortality in critically ill sepsis patients[J]. Shock, 2009, 31(2): 139-145.
[4] Singer AJ, Taylor M, Domingo A, et al. Diagnostic Characteristics of a Clinical Screening Tool in Combination With Measuring Bedside Lactate Level in Emergency Department Patients With Suspected Sepsis[J]. Academic Emergency Medicine, 2014, 21(8): 853-857.
[5] 刘潇, 祝益民, 胥志跃. 重症监护室中脓毒症患儿血乳酸水平与动脉血氧分压相关性分析[J]. 现代医学, 2011(02): 200-202.
[6] 吕晓春, 许强宏, 蔡国龙, 等. ScVO2联合乳酸清除率指导脓毒症休克患者的容量复苏[J]. 中华医学杂志, 2015, 95(07): 496-500.
[7] 田慧艳, 于斌, 胡振杰, 等. 早期乳酸动态监测指标对严重脓毒症及脓毒症休克患者预后的评价[J]. 河北医药, 2015(10): 1449-1453.
[8] 中华医学会儿科学分会急救学组, 中华医学会急诊医学分会儿科学组, 中国医师协会儿童重症医师分会. 儿童脓毒性休克(感染性休克)诊治专家共识(2015版)[J]. 中华实用儿科临床杂志, 2015, 30(22): 1687-1691.
[9] Barochia AV, Cui X, Eichacker PQ. The Surviving Sepsis Campaign's Revised Sepsis Bundles[J]. Curr Infect Dis Rep, 2013, 15(5): 385-393.
[10] Paulsen J, Mehl A, Askim A, et al. Epidemiology and outcome of Staphylococcus aureus bloodstream infection and sepsis in a Norwegian county 1996-2011: an observational study[J]. BMC Infect Dis, 2015, 15: 116.
[11] 黄可强. 血乳酸水平动态监测在ICU患者中的应用价值[J]. 医学综述, 2015(13): 2459-2460.
[12] 谈定玉, 夏仲芳, 郑爱东, 等. 急诊脓毒症死亡风险评分联合血乳酸对急诊严重脓毒症患者危险分层的价值研究[J]. 中华危重病急救医学, 2014, 26(3): 159-164.
[13] Bai Z, Zhu X, Li M, et al. Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission[J]. BMC Pediatr, 2014, 14: 83.
[14] Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis[J]. Intensive Care Med, 2010, 36(2): 222-231.
[15] Scott HF, Donoghue AJ, Gaieski DF, et al. The utility of early lactate testing in undifferentiated pediatric systemic inflammatory response syndrome[J]. Acad Emerg Med, 2012, 19(11): 1276-1280.
[16] Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012[J]. Intensive Care Med, 2013, 39(2): 165-228.
基金
国家十二五科技支撑计划(2012BAI04B01)南华大学研究生科研创新项目(2015XCX56)。
PDF(1255 KB)
