Objective: To evaluate the value of blood lactic acid (BLA) as a predictor for the severity and prognosis of neonatal shock.
Methods: A total of 326 neonates with shock were enrolled and divided into three groups based on the severity, namely mild group (n=147), moderate group (n=105), and severe group (n=74). BLA level was measured during and early after (about 6 hours later) fluid resuscitation, and lactate clearance rate (LCR) was calculated. The receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of BLA in neonatal shock.
Results: BLA level was high in all subjects prior to treatment, and was highest in the severe group and lowest in the mild group (P<0.01). BLA level was significantly higher among patients with septic shock than among those with hypovolemic, cardiogenic, and asphyxiating shock (P<0.05). BLA level was significantly reduced in patients in recovery after treatment (P<0.05). Mortality was significantly lower in patients with BLA level ≤4 mmol/L or LCR ≥10% than in those with BLA level >4 mmol/L or LCR <10% (P<0.01). BLA at 11.15 mmol/L had 100% sensitivity and 96.8% specificity in predicting severe shock. BLA at 10.65 mmol/L had 88.9% sensitivity and 74.1% specificity in predicting the prognosis (survival or dead) of newborns with shock.
Conclusions: In neonates with shock, arterial BLA level increases as the disease severity increases and is associated with prognosis, so it is a useful predictor of the severity and prognosis of neonatal shock.
目的: 探讨血乳酸对新生儿休克严重程度及预后判断的价值。
方法: 326例休克新生儿(轻度147例、中度105例、重度休克74例)在复苏同时及早期复苏后(约6 h)检测动脉血乳酸并计算乳酸清除率。采用受试者工作特征曲线(ROC曲线)评价血乳酸对新生儿休克的预测效能。
结果: 治疗前休克患儿的血乳酸均增高，以重度组最高、轻度组最低(P<0.01)；感染性休克、低血容量性休克、心源性休克和窒息性休克患儿的血乳酸水平以感染性休克最高(P<0.05)；治疗后进入恢复期的休克患儿血乳酸水平明显下降(P<0.05)。血乳酸≤ 4 mmo/L休克患儿的病死率低于乳酸> 4 mmo/L患儿(P<0.01)；乳酸清除率<10%患儿的死亡风险高于清除率≥ 10%患儿(P<0.01)。血乳酸为11.15 mmol/L时，对重度休克预测的灵敏度为100%、特异度为96.8%；血乳酸为10.65 mmol/L时，对休克患儿死亡风险预测的灵敏度为88.9%、特异度为74.1%。
结论: 动脉血乳酸水平随新生儿休克严重程度而增加，且与预后相关，可用于休克严重程度及预后判断。