窒息新生儿血乳酸水平与NCIS评分的关系及两者对预后的影响-东南大学学报医学版

窒息新生儿血乳酸水平与NCIS评分的关系及两者对预后的影响

单位：1. 青海红十字医院新生儿科, 青海西宁 810000;
2. 青海红十字医院检验中心, 青海西宁 810000

分类号：R722.12

出版年·卷·期（页码）：2018·37·第五期（892-895）

摘要：

目的：研究窒息新生儿血乳酸水平与新生儿危重病例评分（NCIS）的关系，及两者对窒息预后的影响。方法：新生儿重症监护室（NICU）收治窒息新生儿83例，入院后24 h内检测血乳酸水平并进行NCIS评分，按照NCIS评分分为非危重组17例，危重组38例，极危重组28例。比较乳酸在不同危重程度患儿中的差异，记录患儿住院期间死亡情况，ROC曲线评估血乳酸水平对预后的诊断价值。结果：不同危重级别窒息新生儿乳酸水平比较差异具有统计学意义（P<0.01）。非危重组乳酸正常比例显著高于其他两组（P<0.05），极危重组乳酸中毒比例显著高于其他两组（P<0.05）。Pearson分析显示窒息新生儿乳酸水平与NCIS评分呈负相关（r=-0.326，P=0.003）。住院期间19例新生儿死亡，死亡组NCIS评分显著低于存活组（P<0.05），乳酸水平显著高于存活组（P<0.05）。新生儿脓毒症的血乳酸ROC曲线AUC为0.742±0.043（95% CI 0.651~0.894，P<0.001），截断值为3.62 mmol·L^-1，敏感度98.6%，特异度95.3%。结论：窒息新生儿血乳酸水平与NCIS评分均可预测窒息危重程度及预后，两者呈负相关关系；窒息新生儿血乳酸水平大于3.62 mmol·L^-1死亡率高。

Objective:To study the relationship between blood lactic acid and neonatal critical illness score (NCIS) and the effect of both on the prognosis of neonates with asphyxia. Methods:83 cases of asphyctic neonates in neonatal intensive care unit (NICU) were enrolled, then lactic acid level and NCIS were evaluated within 24 h. According to the NCIS, the neonates were divided into three groups, including non-critical group (17 cases), critically ill group (38 cases) and critically endangered group (28 cases). Lactic acid level in all neonates with different risk were compared and the death rate were recorded during hospitalization. ROC curve was used to evaluate the diagnostic value of serum lactic acid level on prognosis. Results:The difference of lactic acid level among all groups was statistically significant (P<0.01). The proportion of normal lactic acid level in non-critical groupnon risk group was significantly higher than that in the other two groups (P <0.05), while the proportion of lactic acidosis in critically endangered group was significantly higher than that in the other two groups (P <0.05). Pearson analysis found that the level of lactic acid in asphyctic neonates was negatively correlated with NCIS (r=-0.326, P=0.003). 19 cases of neonates died during hospitalization, meanwhile the NCIS of the death group was significantly lower than that of survival group (P <0.05), and the lactic acid level was significantly higher than that of survival group (P <0.05). AUC of the ROC curve was 0.742±0.043(95% CI 0.651-0.894, P < 0.001), the truncation value was 3.62 mmol·L^-1, sensitivity was 98.6% and specificity was 95.3%. Conclusion:The level of blood lactic acid and NCIS of asphyctic neonates can predict the severity of asphyxia and prognosis, and the level of lactic acid is negatively correlated with NCIS. The mortality rate increases when the level of lactic acid in blood greater than 3.62 mmol·L^-1.

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