论文部分内容阅读
目的探讨5岁以下重症肺炎患儿动脉血乳酸、D-二聚体(DD)和降钙素原(PCT)变化及对早期诊断和预后评估的价值。方法入选5岁以下重症肺炎患儿60例和普通肺炎患儿40例,检测两组患儿动脉血乳酸、DD和PCT水平。根据预后将重症肺炎患儿分为有效组和无效组,比较两组初始及治疗72 h后动脉血乳酸、DD和PCT水平。根据病原体,将肺炎患儿分为细菌组、病毒组及肺炎支原体组,分析3组PCIS评分及初始血乳酸、DD和PCT水平。结果重症肺炎患儿初始血乳酸、DD和PCT水平高于普通肺炎患儿(P均<0.01)。重症肺炎有效组和无效组比较,在治疗前两组血乳酸、DD和PCT水平比较差异无统计学意义(P均>0.05);治疗72 h后,有效组上述指标均低于无效组(P均<0.01);有效组治疗后血乳酸、DD和PCT水平较治疗前有明显改善(P均<0.01);而无效组治疗前后改善不明显(P均>0.05)。细菌性肺炎患儿PCT较病毒性肺炎及肺炎支原体肺炎患儿明显升高(P均<0.01)。结论 5岁以下重症肺炎患儿动脉血乳酸、DD和PCT水平对早期诊断有临床价值。治疗后动脉血乳酸、DD和PCT水平能否较快改善对患儿预后评估有重要意义。PCT是提示5岁以下肺炎患儿细菌感染的良好指标。
Objective To investigate the changes of arterial blood lactic acid, D-dimer (DD) and procalcitonin (PCT) in severe pneumonia in children under 5 years old and its value in early diagnosis and prognosis evaluation. Methods Sixty children with severe pneumonia under 5 years old and 40 children with common pneumonia were enrolled in this study. Arterial blood lactic acid, DD and PCT levels were measured in two groups. The children with severe pneumonia were divided into effective group and ineffective group according to the prognosis. The arterial blood lactic acid, DD and PCT levels were compared between two groups after initial treatment and after 72 hours of treatment. According to the pathogen, children with pneumonia were divided into bacteria group, virus group and Mycoplasma pneumoniae group. PCIS score, initial blood lactate, DD and PCT were analyzed. Results The initial blood lactate, DD and PCT levels in children with severe pneumonia were higher than those in children with common pneumonia (all P <0.01). There were no significant differences in serum lactic acid, DD and PCT levels between the two groups before treatment (P> 0.05). After 72 h of treatment, the above indexes in effective group were lower than those in ineffective group (P (All P <0.01). The levels of lactic acid, DD and PCT in the effective group were significantly improved after treatment (all P <0.01), while those in the invalid group were not improved before and after treatment (P> 0.05). PCT in children with bacterial pneumonia was significantly higher than that in children with viral pneumonia and mycoplasma pneumoniae pneumonia (all P <0.01). Conclusion Arterial blood lactic acid, DD and PCT in children under 5 years old have clinical value in early diagnosis. After treatment of arterial blood lactate, DD and PCT levels can improve the prognosis of children with great significance. PCT is a good indicator of bacterial infection in children under 5 years of age with pneumonia.