Poeze Martijn, Solberg Barbara C J, Greve Jan Willem M, Ramsay Graham
Department of Surgery and Intensive Care Medicine, University Hospital Maastricht, Maastricht, The Netherlands.
Intensive Care Med. 2003 Nov;29(11):2081-5. doi: 10.1007/s00134-003-1944-3. Epub 2003 Oct 8.
Intestinal ischemia causes an increase in lactate production and gastric intramucosal carbon dioxide partial pressure (PgCO(2)). However, no linear relationship between systemic l-lactate levels and gastric tonometry during intestinal ischemia has been found, probably since l-lactate is rapidly cleared from the circulation by the liver. In contrast, the rate of d-lactate clearance from the circulation by the liver is considerably lower than that of l-lactate, and d-lactate may therefore be more closely related to measurements of gastric tonometry than l-lactate values.
Prospective, observational study in a university-affiliated mixed intensive care unit.
Twenty critically ill patients with septic shock.
During the first 24 h of admission to the intensive care unit at least two blood samples were taken for d- and l-lactate measurements and arterial blood gases, Simultaneously, gastric PgCO(2) was measured using capnographic tonometry. The intramucosal-arterial PCO(2) gap was calculated using gastric intramucosal PgCO(2) and arterial PCO(2) from arterial blood. d-Lactate was significantly correlated to PgCO(2) values and to the mucosal-arterial PCO(2) gap. There was no relationship between l-lactate and PgCO(2) or the mucosal-arterial PCO(2) gap. d-lactate and l-lactate values were significantly correlated.
During sepsis intestinal production of d-lactate is related to gastric intramucosal PCO(2). No such relationship was found between l-lactate values and PgCO(2)
肠道缺血会导致乳酸生成增加以及胃黏膜内二氧化碳分压（PgCO₂）升高。然而，在肠道缺血期间，未发现全身左旋乳酸水平与胃张力测定之间存在线性关系，这可能是因为左旋乳酸会被肝脏迅速从循环中清除。相比之下，肝脏从循环中清除右旋乳酸的速率明显低于左旋乳酸，因此右旋乳酸可能比左旋乳酸值与胃张力测定结果的关系更为密切。
在一所大学附属医院的混合重症监护病房进行的前瞻性观察研究。
20例患有脓毒性休克的重症患者。
在重症监护病房入院后的最初24小时内，至少采集两份血样用于测定右旋和左旋乳酸以及动脉血气，同时使用二氧化碳图法张力测定仪测量胃PgCO₂。利用胃黏膜内PgCO₂和动脉血中的动脉PCO₂计算黏膜-动脉PCO₂差值。右旋乳酸与PgCO₂值以及黏膜-动脉PCO₂差值显著相关。左旋乳酸与PgCO₂或黏膜-动脉PCO₂差值之间无相关性。右旋乳酸和左旋乳酸值显著相关。
在脓毒症期间，肠道右旋乳酸的生成与胃黏膜内PCO₂相关。未发现左旋乳酸值与PgCO₂之间存在此类关系。
