| 摘要: |
| [摘要]目的：探讨早期血乳酸水平监测对重症手足口病患儿病情及预后评估的意义。方法：选取2012年1月至2013年12月湖南省儿童医院收治的重症手足口病住院患儿362例，按是否发生脑干脑炎分为危重症组68例和非危重症组294例，按不同预后分为死亡组25例和非死亡组337例。入院时检测血乳酸水平，观察脑干脑炎、肺水肿、肺出血和循环衰竭并发症发生情况，比较不同预后患儿血乳酸水平的差异并分析血乳酸水平对诊断各类并发症的影响。结果：危重症组患儿血乳酸水平为（3.97±3.77）mmol/L，非危重症组为（1.46±0.80）mmol/L；死亡组血乳酸水平为（5.67±4.10）mmol/L，非死亡组为（1.47±0.86）mmol/L，危重症组及死亡组均明显高于非危重症组及非死亡组（P<0.05）。以血乳酸3.2 mmol/L为界值，>3.2 mmol/L组脑干脑炎、肺水肿、循环衰竭、肺出血发生率和病死率较≤3.2 mmol/L组升高，差异有统计学意义（P<0.05）。血乳酸水平诊断肺出血、循环衰竭、预后是否死亡的ROC曲线下面积分别为0.81（0.70，0.92）、0.82（0.74，0.94）、0.85（0.74，0.96）；血乳酸水平以3.2 mmol/L为界值时，最大约登指数为1.69，对预测发生肺水肿、肺出血、循环衰竭和死亡具有较高的敏感度和特异度。结论：血乳酸水平可反映重症手足口病患儿病情及严重程度。入院血乳酸水平>3.2 mmol/L的重症手足口病患儿可能发生肺水肿、肺出血和循环衰竭等严重并发症，甚至死亡。 |
| 关键词: 重症 手足口病 血乳酸 肺出血 预后 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2020.05.001 |
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| 基金项目:2015 年度湖南省卫生和计划生育委员会科研项目,编号 B2015-131;2020 年度湖南省卫生健康委员会科研立项课题,编号20200611。 |
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| Significance of Blood Lactate Level on Condition and Evaluation of Prognosis of Children with Severe Hand-Foot-Mouth Disease |
| Zhou Haiyin, Zuo Chao, Zeng Fangling, Qiu Jun, Liu Pingping, Long Caixia, Luo Lan, Zhao Xiaoping, Xiao Zhenghui |
| (Hunan Children’s Hospital, Huanan Changsha 410007, China) |
| Abstract: |
| [Abstract] Objective: To probe into the significance of blood lactate level on condition and evaluation of prognosis of children with severe hand-foot-mouth disease. Methods: Totally 362 children with severe hand-foot-mouth disease admitted into Hunan Children’s Hospital from Jan. 2012 to Dec. 2013 were extracted as the research objects. According to occurrence of brainstem encephalitis, all patients were divided into 68 cases in the critically ill group and 294 cases in the non-critically ill group. According to different prognosis, all patients were divided into 25 cases in the death group and 337 cases in the non-death group. Blood lactate level was detected after admission. Complications of brainstem encephalitis, pulmonary edema, pulmonary hemorrhage and circulatory failure were observed. Differences of blood lactate level in children with different prognosis were compared, effects of blood lactate level on the diagnosis of various complications were analyzed. Results: The blood lactate level in the critically ill group was (3.97±3.77) mmol/L, and in the non-critically ill group was (1.46±0.80) mmol/L; the blood lactate level in the death group was (5.67±4.10) mmol/L, and in the non-death group was (1.47±0.86) mmol/L; the critically ill group and the death group were significantly higher than the non-critically ill group and the non-death group (P<0.05). Taking the blood lactate level of 3.2 mmol/L as the cut-off value, the incidence and mortality of brainstem encephalitis, pulmonary edema, circulatory failure, pulmonary hemorrhage in the >3.2 mmol/L group were higher than those in the ≤3.2 mmol/L group, and the difference was statistically significant (P<0.05). The area under the ROC curve for the diagnosis of pulmonary hemorrhage, circulatory failure, and prognosis of blood lactate level were 0.81(0.70, 0.92), 0.82(0.74, 0.94), and 0.85(0.74, 0.96). With the blood lactate level of 3.2 mmol/L as the cut-off value, the maximum Youden index was 1.69, which had higher sensitivity and specificity for predicting the occurrence of pulmonary edema, pulmonary hemorrhage, circulatory failure and death. Conclusion: Blood lactate level can reflect the condition and severity of children with severe hand-foot-mouth disease. Children with severe hand-foot-mouth disease with blood lactate level of > 3.2 mmol/L may develop severe complications such as pulmonary edema, pulmonary hemorrhage, and circulatory failure, and even death. |
| Key words: severe hand-foot- mouth disease blood lactate level pulmonary edema prognosis |
