The Clinical Significance Of Lactate Clearance In Children With Septic Shock

Objective: Determine the concentration of plasma lactate level and lactate clearance in children with septic shock before and after fluid resuscitation. Find the changes in the law. Explore the relationship between lactate levels, lactate clearance and prognosis.Methods: 56 children with septic shock were studied. Lactate levels were measured before fluid resuscitation, and 6-hour, 12-hour, 24-hour after fluid resuscitation. Analyse the relationship between lactate,lactate clearance with gender, age, the number of organ dysfunction,PCIS before fluid resuscitation, mechanical ventilation,hospital stays in PICU.Result:1. There did not have a correlation between lactate level before fluid resuscitation with gender,age,PCIS, prognosis, mechanical ventilation and hospital stays in PICU. There had a relation between lactate level before fluid resuscitation with the number of organ dysfunction. The lactate level before fluid resuscitation in septic shock compensatory stage was lower than in septic shock decompensatory stage(P<0.05).2. The 6-hour, 12-hour, 24-hour lactate levels were significantly higher in death group than in survival group(P<0.05). There was a positive correlation between 6-hour, 12-hour, 24-hour lactate clearance after fluid resuscitation and prognosis(P<0.05). 6-hour, 12-hour, 24-hour lactate clearance after fluid resuscitation was more value than lactate levels after fluid resuscitation in evaluate the worth of diagnosis in the prognosis in septic shock through ROC curve, its diagnosis point was 29.9%,55.0%,66.3% respectively. The diagnosis point of 6-hour, 12-hour, 24-hour lactate levels was 2.4mmol/L,1.9mmol/L,1.7mmol/L respectively.3. There did not have a correlation between lactate level after fluid resuscitation, vasoactive substances, mechanical ventilation and hospital stays in PICU. There did not have a correlation between lactate clearance after fluid resuscitation, vasoactive substances, mechanical ventilation and hospital stays in PICU.4. 24-hour lactate level and lactate clearance had significantly relation with PCIS.5. There was a positive correlation between lactate levels after fluid resuscitation and the number of organ dysfunction. There was a negative correlation between lactate clearance after fluid resuscitation and the number of organ dysfunction.Conclusion:1. The lactate level before fluid resuscitation do not affect the prognosis in children with septic shock. The prognosis in children with septic shock are influenced by the lactate level and lactate clearance after fluid resuscitation. So the fluid resuscitation is important for it affected the prognosis.2. The lactate level before fluid resuscitation in septic shock compensatory stage is lower than in septic shock decompensatory stage significantly.3. 6-hour, 12-hour, 24-hour lactate clearance after fluid resuscitation are more value than lactate levels after fluid resuscitation in forecast the prognosis in septic shock, their diagnosis point are 29.9%,55.0%,66.3% respectively. The diagnosis point of 6-hour, 12-hour, 24-hour lactate levels are 2.4mmol/L,1.9mmol/L,1.7mmol/L respectively.4. The number of organ dysfunction have a relationship with the lactate levels before and after fluid resuscitation and lactate clearance.5. It did not found the relationship between Vasoactive substances, mechanical ventilation with the prognosis in children with septic shock now.