摘要
目的探讨脓毒症患儿红细胞分布宽度(red blood cell distribution width,RDW)、小儿危重症评分(pediatric critical illness score,PCIS)和血乳酸的变化及与预后的关系。方法收集某医院重症监护室(intensive care unit,ICU)脓毒症患儿204例,入院后进行小儿危重症评分,并检测24 h内血RDW和乳酸水平。根据临床转归及病情严重程度分组,比较各组血RDW、乳酸的水平及PCIS评分,对血RDW和乳酸及PCIS评分进行相关性研究。结果存活组PCIS评分、RDW(%)、LAC(mmol/L)分别为76.84±3.79,14.12%±0.10%和1.24±1.01 mmol/L,死亡组为71.13±5.55,16.21%±0.32%和4.38±4.27 mmol/L,死亡组较存活组PCIS评分降低,RDW及乳酸水平升高,差异均有统计学意义(t=-8.29,8.06,8.33,均P<0.05)。三项指标与PCIS 71~80组(14.44%±1.69%,1.70±2.37 mmol/L和18.3%)相比,PCIS≤70组(15.73%±2.25%,3.76±3.61 mmol/L和62.9%)RDW及乳酸水平均升高,死亡率增加,差异均有统计学意义(t=3.87,4.22,χ^2=13.08,均P<0.05)。三项指标与非严重脓毒症组(77.09±3.65,14.26%±1.57%,1.18±1.42 mmol/L和8.18%)相比,严重脓毒症组(73.34±5.56,15.13%±2.06%,3.08±2.99 mmol/L和46.8%)PCIS评分降低,RDW、乳酸水平及死亡率均升高,差异均有统计学意义(t=5.77,3.4,5.28,χ^2=21.63,均P<0.05)。与RDW≤14.0组(76.54±4.47,1.57±2.12 mmol/L和12%)相比,RDW>14.0组(74.53±5.17,2.40±3.04 mmol/L和36%)PCIS评分降低,乳酸水平和死亡率升高,差异均有统计学意义(t=-2.89,2.18,χ^2=8.09,均P<0.05);RDW水平与PCIS评分呈正态分布,两者呈负相关(r=-0.305 7,P<0.05),RDW水平与乳酸水平呈正相关(r=0.195 4,P<0.05)。结论严重脓毒症患儿及死亡患儿入院24 h内RDW水平明显升高,RDW水平与PCIS评分及乳酸水平具有相关性,RDW水平与脓毒症患儿疾病严重程度和死亡率相关,RDW适用于评价脓毒症患儿危重程度和预后。
Objective To investigate the relationship between red cell distribution width(RDW) and pediatric critical illness score(PCIS),serum lactic acid as well as prognosis in pediatric patients with sepsis.Methods 204 children with sepsis were analyzed retrospectively.The level of RDW,blood lactic acid were measured within 24 hours after admission,the pediatric critical illness score were meanwhile record.The patients were divided into different groups according to clinical outcomes and severity of sepsis.The level of RDW,blood lactic acid and PCIS were compared between these groups.In addition correlation studies between the above indexes and RDW were analyzed.Results The PCIS of death group decreased significantly compared with survival group,the average RDW and the level of blood lactic acid of death group increased significantly compared with survival group [(71.13±5.55,16.21%±0.32% and 4.38±4.27 mmol/L) vs(76.84±3.79,14.12%±0.10% and 1.24±1.01 mmol/L),the differences were statistically significant(t=-8.29,8.06,8.33,all P<0.05)].The average RDW,the level of blood lactic acid and themortality of PCIS≤70 group increased significantly compared with PCIS 71~80 group [(15.73%±2.25%,3.76±3.61 mmol/L and 62.9%) vs(14.44%±1.69%,1.70±2.37 mmol/L and 18.3%)],the differences were statistically significant(t=3.87,4.22,χ^2=13.08,all P<0.05).The PCIS of sever sepsis group decreased significantly compared with Non-severe sepsis group,the average RDW,the level of blood lactic acid and the mortality of sever sepsis group increased significantly compared with Non-severe sepsis group [(73.34±5.56,15.13%±2.06%,3.08±2.99 mmol/L and 46.8%) vs(77.09±3.65,14.26%±1.57%,1.18±1.42 mmol/L and 8.18%)],the differences were statistically significant(t=5.77,3.4 5.28,χ^2=21.63,all P<0.05).The PCIS of RDW>14.0 group decreased significantly compared with RDW≤14.0 group,the level of blood lactic acid and the mortality of RDW>14.0 group increased significantly compared with RDW≤14.0 group [(74.53±5.17,2.40±3.04 mmol/L and 36%)
作者
余莉
郭勇
车襣
吴婕翎
邓钰红
YU Li;GUO Yong;CHE Di;WU Jie-ling;DENG Yu-hong(Department of Child Healthcare,Guangdong Womenand Children Hospital Affiliared to Guangzhou Medical College,Guangzhou 511400,China)
出处
《现代检验医学杂志》
CAS
2019年第3期86-90,共5页
Journal of Modern Laboratory Medicine
关键词
红细胞分布宽度
脓毒症
小儿危重病评分
乳酸
red blood cell distribution width
sepsis
pediatric critical illness score
lactate
