吴敏?陈捷?曾丽娜?陈丰?蔡翠仙

[摘要] 目的 研究血乳酸及乳酸清除率监测在小儿脓毒性休克的临床意义。 方法 选取2013年5月11日～2016年5月11日我院收治的脓毒性休克患儿32例为研究對象，患儿入院后均接受早期的目标导向治疗，按照治疗结果分为两组，分别为存活组25例，死亡组7例；对比分析两组患儿治疗后0、6、12、24小时对应的危重病评分APACHEII评分。 结果 0小时死亡组动脉乳酸值为（14.80±1.25）mol/L、APACHEII评分（28.00±4.05）分，明显高于存活组动脉乳酸值（6.32±1.24）mol/L、APACHEII评分（18.05±3.2）分；6小时死亡组动脉乳酸值为（15.45±2.04）mol/L、APACHEII评分（30.00±3.95）分，明显高于存活组动脉乳酸值（3.18±1.10）mol/L、APACHEII评分（15.61±2.22）分；死亡组患儿早期6h乳酸清除率（9.58±1.05）%，明显低于存活组（43.01±3.29）%，存活组12h乳酸清除率（67.14±2.31）%，存活组24h乳酸清除率（76.55±2.77）%。 结论 血乳酸及乳酸清除率监测对评估患儿感染休克程度和复苏治疗有很好的效果。

[关键词] 血乳酸；乳酸清除；脓毒性休克；监测

[中图分类号] R459.7 [文献标识码] A [文章编号] 2095-0616（2017）07-234-03

Clinical significance of monitoring of blood lactate and lactate clearance rate in septic shock of children

WU Min CHEN Jie ZENG Lina CHEN Feng CAI Cuixian

Yangjiang People's Hospital，Yangjiang 529500，China

[Abstract] Objective To study the clinical significance of monitoring of blood lactate and lactate clearance rate in septic shock of children. Methods 32 cases of septic shock cured in our hospital from May 11，2013 to May 11，2016 were selected as the research objects.All children received early goal-directed therapy after admission.And according to the treatment outcome，they were divided into the survival group with 25 cases and the death group with 7 cases. The critical illness APACHEII scores on 0 hours， 6 hours， 12 hours， and 24 hours after treatment were compared and analyzed. Results Arterial lactate and APACHEII score in 0 hour of the death group were respectively （14.80±1.25）mol/L and （28.00±4.05），significantly higher than those of survival group （6.32±1.24）mol/L and （18.05±3.2）.Arterial lactate and APACHEII score in 6 hours of the death group were respectively （15.45±2.04）mol/L and （30.00±3.95），significantly higher than those of survival group （3.18±1.10）mol/L and （15.61±2.22）.Early 6h lactate clearance rate in the death group was （9.58+1.05）%，which was significantly lower than that of survival group （43.01±3.29）%.12h lactate clearance rate of survival group was （67.14±2.31）% and 24h lactate clearance rate of survival group was （76.55±2.77）%. Conclusion Monitoring of blood lactate and lactate clearance rate has a good effect on the evaluation of the degree of septic shock and resuscitation.

[Key words] Blood lactate；Lactate clearance；Septic shock；Monitor

脓毒症是指由可疑或被证实的感染引发全身炎症反应的疾病，会引起血流分布异常和动静脉短路等脓毒性休克，损害细胞和器官功能，严重影响儿童的身体健康[1-2]。脓毒症病情凶险，有很高的致死率，细胞无氧呼吸代谢的重要产物就是乳酸，乳酸可以对细胞氧代谢能力和组织灌溉状态进行评估，据有关统计数据显示，治疗6h后乳酸水平与休克后组织缺氧程度有密切的关系[3]。本研究探讨血乳酸及乳酸清除率与患儿治疗恢复的关系，对32例脓毒性休克患儿血乳酸和乳酸清除率进行持续监测，取得了比较满意的结果，现报道如下。……