Bakker J, Coffernils M, Leon M, Gris P, Vincent J L
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Chest. 1991 Apr;99(4):956-62. doi: 10.1378/chest.99.4.956.
Recent reports have shown that oxygen delivery (Do2) and oxygen uptake (Vo2) could be related to outcome of critically ill patients. In this study, we examined measurements of cardiac output, oxygen-derived variables, and blood lactate levels in 48 patients with documented septic shock. There were 27 survivors and 21 nonsurvivors from the shock episode. For all 174 observations, there was a significant linear relationship between Vo2 and Do2 (Vo2 = 79 + 0.17 x Do2, r = 0.64, p less than 0.001). There were no significant differences in Do2 between survivors and nonsurvivors at the onset of septic shock (mean +/- SD, 540 +/- 219 vs 484 +/- 222 ml/min.m2, NS) or in the final phase of septic shock (506 +/- 163 vs 443 +/- 187 ml/min.m2, NS). Also, no significant differences were found in Vo2 and oxygen extraction between survivors and nonsurvivors. However, survivors had significantly lower blood lactate levels both initially (5.1 +/- 2.7 vs 8.2 +/- 5.4 mmol/L, p less than 0.05) and in the final phase of septic shock (2.6 +/- 1.9 vs 7.7 +/- 5.6 mmol/L, p less than 0.001). Only the survivors had a significant decrease in blood lactate levels during the course of septic shock (p less than 0.001). We conclude that the oxygen-derived variables, Do2 and Vo2, cannot be used as prognostic indicators in human septic shock. In contrast, blood lactate levels are closely related to ultimate survival from septic shock. Furthermore, decreases in blood lactate levels during the course of septic shock could indicate a favorable outcome. Therefore, blood lactate levels can serve as a reliable clinical guide to therapy.
近期报告显示，氧输送（Do2）和氧摄取（Vo2）可能与危重症患者的预后相关。在本研究中，我们检测了48例确诊为感染性休克患者的心输出量、氧衍生变量及血乳酸水平。休克发作后有27例幸存者和21例非幸存者。在全部174次观察中，Vo2与Do2之间存在显著的线性关系（Vo2 = 79 + 0.17×Do2，r = 0.64，p＜0.001）。在感染性休克发作时，幸存者与非幸存者的Do2无显著差异（均值±标准差，540±219 vs 484±222 ml/min·m2，无统计学意义），在感染性休克末期也无显著差异（506±163 vs 443±187 ml/min·m2，无统计学意义）。此外，幸存者与非幸存者在Vo2及氧摄取方面也未发现显著差异。然而，幸存者无论是最初（5.1±2.7 vs 8.2±5.4 mmol/L，p＜0.05）还是在感染性休克末期（2.6±1.9 vs 7.7±5.6 mmol/L，p＜0.001）的血乳酸水平均显著更低。只有幸存者在感染性休克过程中血乳酸水平有显著下降（p＜0.001）。我们得出结论，氧衍生变量Do2和Vo2不能用作人类感染性休克的预后指标。相反，血乳酸水平与感染性休克的最终存活密切相关。此外，感染性休克过程中血乳酸水平的下降可能预示良好预后。因此，血乳酸水平可作为可靠的临床治疗指导。
