乳酸水平作为小儿肠套叠患者在急诊科的结局预测指标。
Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department.
机构信息
Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
出版信息
BMC Pediatr. 2020 Apr 24;20(1):184. doi: 10.1186/s12887-020-02095-9.
BACKGROUND
Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes.
METHODS
The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 h of reduction or when surgical reduction was required due to air enema failure.
RESULTS
A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥ 1.5, ≥2.0, ≥2.5, and ≥ 3.0 mmol/L, the positive predictive values for poor outcomes were 30.0, 34.6, 50.0, and 88.9%, respectively.
CONCLUSION
Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.
背景
肠套叠会减少肠道血流，组织灌注不足会导致乳酸水平升高。我们旨在确定乳酸水平是否与小儿肠套叠的结果有关。
方法
回顾了 2015 年 1 月至 2018 年 10 月期间我院急诊科诊断为肠套叠的儿科患者的电子病历。如果肠套叠在复位后 48 小时内复发或因气钡灌肠失败而需要手术复位，则认为结果较差。
结果
共有 249 例患者纳入研究，其中 39 例发生肠套叠复发，11 例需要手术复位；因此，50 例患者纳入不良结局组。不良结局组和良好结局组的血气分析 pH 值（7.39 比 7.41，P = 0.001）、乳酸（1.70 比 1.30 mmol/L，P < 0.001）和碳酸氢盐（20.70 比 21.80 mmol/L，P = 0.036）有显著差异。多变量逻辑回归分析表明，pH 值和乳酸水平是与不良结局显著相关的两个因素。当乳酸水平截断值分别为≥1.5、≥2.0、≥2.5 和≥3.0 mmol/L 时，不良结局的阳性预测值分别为 30.0%、34.6%、50.0%和 88.9%。
结论
乳酸水平影响小儿肠套叠患者的结局；乳酸水平越高，不良结局的阳性预测值越高。
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