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目的:研究血乳酸、乳酸清除率持续监测对感染性休克患儿液体复苏的指导价值。方法:回顾分析本院64例感染性休克患儿病例资料,患儿入院后均接受积极的早期目标导向治疗(EGDT),根据治疗结果分为存活组36例和死亡组28例。治疗期间持续监测两组治疗初始、6 h、12 h、24 h的血乳酸值,动态观察乳酸清除率的变化并记录复苏治疗6 h后的乳酸清除率。结果:存活组血乳酸值在EGDT液体复苏治疗后呈逐渐下降趋势,治疗6 h、12 h、24 h后血乳酸值较治疗初始值低,差异具有统计学意义(P<0.05)。死亡组治疗后血乳酸值整体仍呈较高水平表达,且在治疗12 h、24h后有回升提高的趋势;存活组血乳酸值在液体复苏治疗后6 h、12 h、24 h均低于死亡组,差异具有统计学意义(P<0.05),乳酸清除率在上述时点均高于死亡组,差异具有统计学意义(P<0.05)。结论:血乳酸值、乳酸清除率的变化和组织缺氧休克程度紧密相关,早期血乳酸值、乳酸清除率的持续监测有助于评估患儿感染休克程度和复苏疗效,为改善临床液体复苏治疗、判断预后提供了依据。
Objective: To study the value of continuous monitoring of blood lactic acid and lactic acid clearance in the recovery of fluid in children with septic shock. Methods: The data of 64 cases of septic shock in our hospital were retrospectively analyzed. All patients received positive early target-oriented therapy (EGDT) after admission. According to the results of treatment, they were divided into survival group (36 cases) and death group (28 cases). During the treatment period, the blood lactic acid value of the initial treatment group, 6 h, 12 h and 24 h was monitored. The changes of lactic acid clearance rate were observed dynamically and the lactic acid clearance rate was recorded 6 h after resuscitation. Results: The blood lactic acid value of surviving group decreased gradually after EGDT liquid resuscitation. The blood lactic acid value of 6 h, 12 h and 24 h after treatment was lower than the initial value of treatment, the difference was statistically significant (P <0.05). After treatment, the blood lactate level in the death group remained high, and the recovery rate increased after 12 and 24 h treatment. The blood lactate level in the survival group was lower than that at 6 h, 12 h and 24 h after liquid resuscitation (P <0.05). The rate of lactic acid clearance was higher than that of death group at the above time point, the difference was statistically significant (P <0.05). CONCLUSION: The changes of blood lactate and lactic acid clearance are closely related to the degree of tissue hypoxia shock. The continuous monitoring of early blood lactic acid and lactic acid clearance may help to evaluate the degree of septic shock and recovery in children. To improve the clinical efficacy of liquid resuscitation , To determine the prognosis provides the basis.