Rimachi R, Bruzzi de Carvahlo F, Orellano-Jimenez C, Cotton F, Vincent J L, De Backer D
Department of Intensive Care, Université Libre de Bruxelles, Brussels, Belgium.
Anaesth Intensive Care. 2012 May;40(3):427-32. doi: 10.1177/0310057X1204000307.
In this prospective, observational study, we measured arterial lactate and pyruvate concentrations within the first four hours of shock and at four hour intervals during the first 24 hours in 26 patients with septic and 13 with cardiogenic shock. We also studied 10 intensive care unit patients with normal lactate levels as controls. Seven patients (18%) died during the first 24 hours of shock, 12 (31%) patients died later in the intensive care unit and 21 (54%) were discharged alive from the intensive care unit. Blood lactate values were higher at shock onset in the non-survivors than in the survivors (P=0.02) and remained significantly elevated throughout the study. The lactate/pyruvate ratio at shock onset was significantly higher in the non-survivors (24 [17 to 34] vs 15 [10 to 19], P=0.01) than in the survivors. All patients with cardiogenic shock had hyperlactataemia at the onset of shock, and 69% had a high lactate/pyruvate ratio. Only 65% of patients with septic shock had hyperlactataemia at the onset of shock and 76% of these also had a high lactate/pyruvate ratio. In conclusion, the lactate/pyruvate ratio confirms that hyperlactataemia is frequently, but not solely, due to hypoxia, especially at the onset of shock.
在这项前瞻性观察研究中，我们测量了26例脓毒性休克患者和13例心源性休克患者在休克最初4小时内以及最初24小时内每4小时一次的动脉血乳酸和丙酮酸浓度。我们还研究了10例乳酸水平正常的重症监护病房患者作为对照。7例患者（18%）在休克最初24小时内死亡，12例患者（31%）随后在重症监护病房死亡，21例患者（54%）从重症监护病房存活出院。非存活者休克发作时的血乳酸值高于存活者（P = 0.02），且在整个研究过程中一直显著升高。非存活者休克发作时的乳酸/丙酮酸比值显著高于存活者（24[17至34]比15[10至19]，P = 0.01）。所有心源性休克患者在休克发作时均有高乳酸血症，69%的患者乳酸/丙酮酸比值升高。只有65%的脓毒性休克患者在休克发作时有高乳酸血症，其中76%的患者乳酸/丙酮酸比值也升高。总之，乳酸/丙酮酸比值证实高乳酸血症经常但并非仅仅是由于缺氧，尤其是在休克发作时。
