Meregalli André, Oliveira Roselaine P, Friedman Gilberto
Central Intensive Care Unit of the Santa Casa Hospital, Porto Alegre, Brazil.
Crit Care. 2004 Apr;8(2):R60-5. doi: 10.1186/cc2423. Epub 2004 Jan 12.
Our aim was to examine whether serial blood lactate levels could be used as predictors of outcome.
We prospectively studied 44 high-risk, hemodynamically stable, surgical patients. Blood lactate values, mean arterial pressure, heart rate and urine output were obtained at patient admission to the study, at 12, 24 and 48 hours.
The nonsurvivors (n = 7) had similar blood lactate levels initially (3.1 +/- 2.3 mmol/l versus 2.2 +/- 1.0 mmol/l, P = not significant [NS]), but had higher levels after 12 hours (2.9 +/- 1.7 mmol/l versus 1.6 +/- 0.9 mmol/l, P = 0.012), after 24 hours (2.1 +/- 0.6 mmol/l versus 1.5 +/- 0.7 mmol/l, P = NS) and after 48 hours (2.7 +/- 1.8 mmol/l versus 1.9 +/- 1.4 mmol/l, P = NS) as compared with the survivors (n = 37). Arterial bicarbonate concentrations increased significantly in survivors and were higher than in nonsurvivors after 24 hours (22.9 +/- 5.2 mEq/l versus 16.7 +/- 3.9 mEq/l, P = 0.01) and after 48 hours (23.1 +/- 4.1 mEq/l versus 17.6 +/- 7.1 mEq/l, P = NS). The PaO2/FiO2 ratio was higher in survivors initially (334 +/- 121 mmHg versus 241 +/- 133 mmHg, P = 0.03) and remained elevated for 48 hours. There were no significant differences in mean arterial pressure, heart rate, and arterial blood oxygenation at any time between survivors and nonsurvivors. The intensive care unit stay (40 +/- 42 hours versus 142 +/- 143 hours, P < 0.001) and the hospital stay (12 +/- 11 days versus 24 +/- 17 days, P = 0.022) were longer for nonsurvivors than for survivors. The Simplified Acute Physiology Score II score was higher for nonsurvivors than for survivors (34 +/- 9 versus 25 +/- 14, P = NS). The urine output was slightly lower in the nonsurvivor group (P = NS). The areas under the receiving operating characteristic curves were larger for initial values of Simplified Acute Physiology Score II and blood lactate for predicting death.
Elevated blood lactate levels are associated with a higher mortality rate and postoperative complications in hemodynamically stable surgical patients.
我们的目的是研究连续血乳酸水平是否可作为预后的预测指标。
我们前瞻性地研究了44例高危、血流动力学稳定的外科手术患者。在患者纳入研究时、12小时、24小时和48小时时获取血乳酸值、平均动脉压、心率和尿量。
非存活者（n = 7）最初的血乳酸水平相似（3.1±2.3 mmol/L对2.2±1.0 mmol/L，P =无显著性差异[NS]），但在12小时后（2.9±1.7 mmol/L对1.6±0.9 mmol/L，P = 0.012）、24小时后（2.1±0.6 mmol/L对1.5±0.7 mmol/L，P = NS）和48小时后（2.7±1.8 mmol/L对1.9±1.4 mmol/L，P = NS）高于存活者（n = 37）。存活者的动脉血碳酸氢盐浓度显著升高，在24小时后（22.9±5.2 mEq/L对16.7±3.9 mEq/L，P = 0.01）和48小时后（23.1±4.1 mEq/L对17.6±7.1 mEq/L，P = NS）高于非存活者。存活者最初的PaO2/FiO2比值较高（334±121 mmHg对241±133 mmHg，P = 0.03），并在48小时内保持升高。存活者和非存活者在任何时候的平均动脉压、心率和动脉血氧合方面均无显著差异。非存活者的重症监护病房住院时间（40±42小时对142±143小时，P < 0.001）和住院时间（12±11天对24±17天，P = 0.022）比存活者长。非存活者的简化急性生理学评分II分值高于存活者（34±9对25±14，P = NS）。非存活者组的尿量略低（P = NS）。简化急性生理学评分II初始值和血乳酸预测死亡的受试者工作特征曲线下面积更大。
血流动力学稳定的外科手术患者血乳酸水平升高与较高的死亡率和术后并发症相关。
