Duke T D, Butt W, South M
Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Melbourne, Australia.
Intensive Care Med. 1997 Jun;23(6):684-92. doi: 10.1007/s001340050394.
To assess the markers of perfusion which best discriminate survivors from non-survivors of childhood sepsis and to compare the information derived from gastric tonometry with conventionally measured haemodynamic and laboratory parameters.
Prospective clinical study of children with sepsis syndrome or septic shock.
Paediatric intensive care unit in a tertiary referral centre.
31 children with sepsis syndrome or septic shock.
A tonometer was passed into the stomach via the orogastric route.
The following data were recorded at admission, 12, 24 and 48 h: heart rate, mean arterial pressure, arterial pH, base deficit, arterial lactate, gastric intramucosal pH (pHi) and DCO2 (intramucosal carbon dioxide tension minus arterial partial pressure of carbon dioxide). The principal outcome measure was. The secondary outcome measure was the number of organ systems failing at 48 h after admission. There were 10 deaths and 21 survivors. No variable discriminated survival from death at presentation. Blood lactate level was the earliest discriminator of survival. Using univariate logistic regression, lactate discriminated survivors from those who died at 12 and 24 h after admission, but not at 48 h (p = 0.049, 0.044 and 0.062, respectively). The area under the receiver operating characteristic (ROC) curve for lactate was 0.81, 0.88 and 0.89 at 12, 24 and 48 h, respectively. At 12 h after admission, a blood lactate level > 3 mmol/l had a positive predictive value for death of 56% and a lactate level of 3 mmol/l or less had a positive predictive value for survival of 84%. At 24 h a lactate level > 3 mmol/l had a positive predictive value for death of 71% and a level of 3 mmol/l or less had a positive predictive value for survival of 86%. No other variable identified non-survivors from survivors at 12 h. Gastric tonometry could only be done on 19 of the 31 children, of whom 8 died and 11 survived. In these 19 children, DCO2 measured at 24 h, but not at 12 or 48 h, distinguished those who died from those who survived (p = 0.045 and p = 0.20, respectively). The area under the ROC curve for DCO2 measured at 24 h as a predictor of survival was 0.71. Neither the absolute value of pHi nor the trend of change in pHi at any time in the first 48 h identified survivors in this series. The mean arterial pressure distinguished survivors from non-survivors at 24 and 48 h (area under ROC curve = 0.80 and 0.78, respectively). The base deficit and heart rate did not identify non-survivors from survivors at any time in the first 48 h.
Blood lactate level was the earliest predictor of outcome in children with sepsis. In this group of patients, gastric tonometry added little to the clinical information that could be derived more simply by other means.
评估能最佳区分儿童脓毒症幸存者与非幸存者的灌注指标，并比较经胃张力测定法获取的信息与传统测量的血流动力学及实验室参数。
对脓毒症综合征或感染性休克患儿进行的前瞻性临床研究。
三级转诊中心的儿科重症监护病房。
31例脓毒症综合征或感染性休克患儿。
通过口胃途径将张力计置入胃内。
在入院时、12小时、24小时和48小时记录以下数据：心率、平均动脉压、动脉血pH值、碱缺失、动脉血乳酸、胃黏膜内pH值（pHi）和DCO2（黏膜内二氧化碳分压减去动脉血二氧化碳分压）。主要观察指标是……次要观察指标是入院后48小时出现功能衰竭的器官系统数量。共有10例死亡，21例存活。在入院时，没有任何变量能够区分存活者与死亡者。血乳酸水平是存活的最早判别指标。采用单因素逻辑回归分析，乳酸可在入院后12小时和24小时区分存活者与死亡者，但在48小时时不能区分（p值分别为0.049、0.044和0.062）。乳酸在12小时、24小时和48小时的受试者工作特征（ROC）曲线下面积分别为0.81、0.88和0.89。入院后12小时，血乳酸水平>3 mmol/L对死亡的阳性预测值为56%，乳酸水平≤3 mmol/L对存活的阳性预测值为84%。在24小时时，乳酸水平>3 mmol/L对死亡的阳性预测值为71%，乳酸水平≤3 mmol/L对存活的阳性预测值为86%。在12小时时，没有其他变量能够区分非存活者与存活者。31例患儿中只有19例能够进行胃张力测定，其中8例死亡，11例存活。在这19例患儿中，24小时时测量的DCO2（而非12小时或48小时时测量的）能够区分死亡者与存活者（p值分别为0.045和0.20）。24小时时测量的DCO2作为存活预测指标的ROC曲线下面积为0.71。在本研究系列中，pHi的绝对值及最初48小时内任何时间pHi的变化趋势均不能区分存活者。平均动脉压在24小时和48小时时能够区分存活者与非存活者（ROC曲线下面积分别为0.80和0.78）。碱缺失和心率在最初48小时内的任何时间均不能区分非存活者与存活者。
血乳酸水平是儿童脓毒症预后的最早预测指标。在这组患者中，胃张力测定法所提供的临床信息，通过其他更简单的方法也能获得，因而其作用不大。
