Attanà Paola, Lazzeri Chiara, Chiostri Marco, Picariello Claudio, Gensini Gian Franco, Valente Serafina
Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. paola_
Acute Card Care. 2013 Sep;15(3):58-62. doi: 10.3109/17482941.2013.776691. Epub 2013 Jun 27.
Assess if acid-base evaluation by Stewart's approach had a clinical role in cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI).
There are three widely used approaches to investigate metabolic acidosis: base excess (BE), anion gap (AG) and the Stewart's approach or strong ion gap (SIG). Available studies suggest the usefulness of SIG in sepsis and trauma. No data are so far available in CS.
We enrolled 63 consecutive patients with CS following STEMI submitted to Percutaneous Coronary Intervention (PCI). On admission, the APACHE II (Acute physiology and chronic health evaluation II) score and HOMA (Homeostasis model assessment) index were assessed together with glomerular filtration rate (eGFR), quantitative BE, AG, lactate values and 12 h lactate clearance. Non-survivors showed a higher incidence of PCI failure, higher APACHE II score, lower LVEF, lower eGFR, lower 12 h lactate clearance; a higher admission lactate and more negative BE. No difference was detectable in AG and SIG. Only 3 patients exhibited pathological values of SIG (≥ 2) and only 1 of these patients died.
According to our data the SIG approach does not seem to add further information to usual parameters in acid-base evaluation or early risk stratification in CS patients.
评估采用斯图尔特方法进行酸碱评估在ST段抬高型心肌梗死（STEMI）后心源性休克（CS）中是否具有临床作用。
有三种广泛用于研究代谢性酸中毒的方法：碱剩余（BE）、阴离子间隙（AG）以及斯图尔特方法或强离子间隙（SIG）。现有研究表明SIG在脓毒症和创伤中有用。目前尚无关于CS的相关数据。
我们纳入了63例连续的STEMI后发生CS并接受经皮冠状动脉介入治疗（PCI）的患者。入院时，评估急性生理与慢性健康状况评分系统II（APACHE II）、稳态模型评估（HOMA）指数以及肾小球滤过率（eGFR）、定量BE、AG、乳酸值和12小时乳酸清除率。非存活者的PCI失败发生率更高、APACHE II评分更高、左心室射血分数（LVEF）更低、eGFR更低、12小时乳酸清除率更低；入院时乳酸水平更高且BE更负。AG和SIG无差异。仅3例患者出现SIG病理值（≥2），其中仅1例患者死亡。
根据我们的数据，SIG方法似乎并未为CS患者酸碱评估或早期风险分层的常规参数增加更多信息。
