De Jonghe B, Cheval C, Misset B, Timsit J F, Garrouste M, Montuclard L, Carlet J
Service de Reanimation Polyvalente, Fondation-Hopital Saint-Joseph, Paris, France.
J Crit Care. 1999 Mar;14(1):7-11. doi: 10.1016/s0883-9441(99)90002-3.
The purpose of this study was to assess the influence of early hepatic dysfunction on lactate level in patients with acute circulatory failure in a retrospective study.
Blood lactate was compared between patients in acute circulatory failure (systolic blood pressure < or = 80 mm Hg despite fluid challenge) with or without early hepatic dysfunction (bilirubin > 60 micromol/L or SGOT > 100 IU/L during the first 48 hours). Univariate and multivariate analysis were performed to assess the effects of early hepatic dysfunction and other clinical and biological data on serum lactate levels in patients with acute circulatory failure.
The study included 92 patients, mean age 64+/-15 years, mean simplified acute physiology score (SAPS) 18.4+/-4.1. Early hepatic dysfunction was identified in 29 patients (32%). Mean initial blood lactate was 5.54+/-4.78 mmol/L. Overall intensive care unit mortality was 67.3%. Although patients with and without hepatic dysfunction showed no significant difference in terms of mean SAPS, mean lowest systolic blood pressure, and mortality, serum lactate was higher in the group with hepatic dysfunction than in the group without hepatic dysfunction (8.24+/-6.49 mmol/L v4.29+/-3.09 mmol/L, P < .001). Factors independently associated with serum lactate were the existence of early hepatic dysfunction (P < .01), a nondistributive type of shock (P < .05), and the mean initial amount of epinephrine (P < .05).
This study suggests that early hepatic dysfunction plays an important role in serum lactate elevation in acute circulatory failure.
本回顾性研究旨在评估早期肝功能障碍对急性循环衰竭患者乳酸水平的影响。
比较急性循环衰竭患者（尽管进行了液体复苏，收缩压仍≤80 mmHg）中有无早期肝功能障碍（最初48小时内胆红素>60 μmol/L或谷草转氨酶>100 IU/L）时的血乳酸水平。进行单因素和多因素分析，以评估早期肝功能障碍及其他临床和生物学数据对急性循环衰竭患者血清乳酸水平的影响。
本研究纳入92例患者，平均年龄64±15岁，平均简化急性生理学评分（SAPS）为18.4±4.1。29例患者（32%）存在早期肝功能障碍。平均初始血乳酸为5.54±4.78 mmol/L。重症监护病房总体死亡率为67.3%。尽管有无肝功能障碍的患者在平均SAPS、平均最低收缩压和死亡率方面无显著差异，但肝功能障碍组的血清乳酸水平高于无肝功能障碍组（8.24±6.49 mmol/L对4.29±3.09 mmol/L，P<.001）。与血清乳酸独立相关的因素为早期肝功能障碍的存在（P<.01）、非分布性休克类型（P<.05）和肾上腺素的平均初始用量（P<.05）。
本研究提示早期肝功能障碍在急性循环衰竭患者血清乳酸升高过程中起重要作用。
