Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Mayo Clin Proc. 2013 Oct;88(10):1127-40. doi: 10.1016/j.mayocp.2013.06.012.
Lactate levels are commonly evaluated in acutely ill patients. Although most often used in the context of evaluating shock, lactate levels can be elevated for many reasons. While tissue hypoperfusion may be the most common cause of elevation, many other etiologies or contributing factors exist. Clinicians need to be aware of the many potential causes of lactate level elevation as the clinical and prognostic importance of an elevated lactate level varies widely by disease state. Moreover, specific therapy may need to be tailored to the underlying cause of elevation. The present review is based on a comprehensive PubMed search between the dates of January 1, 1960, to April 30, 2013, using the search term lactate or lactic acidosis combined with known associations, such as shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine, malignancy, liver, toxins, overdose, and medication. We provide an overview of the pathogenesis of lactate level elevation followed by an in-depth look at the varied etiologies, including medication-related causes. The strengths and weaknesses of lactate as a diagnostic/prognostic tool and its potential use as a clinical end point of resuscitation are discussed. The review ends with some general recommendations on the management of patients with elevated lactate levels.
乳酸水平在急性疾病患者中通常会被评估。虽然乳酸水平的检测通常用于评估休克，但升高也可能有很多其他原因。虽然组织灌注不足可能是导致乳酸水平升高的最常见原因，但还有许多其他病因或促成因素存在。临床医生需要了解乳酸水平升高的许多潜在原因，因为乳酸水平升高的临床和预后意义因疾病状态而异。此外，具体的治疗可能需要根据升高的根本原因来定制。本综述基于 1960 年 1 月 1 日至 2013 年 4 月 30 日期间在 PubMed 上进行的一次全面搜索，使用的搜索词为乳酸或乳酸性酸中毒，并结合了已知的关联，如休克、败血症、心搏骤停、创伤、癫痫发作、缺血、糖尿病酮症酸中毒、硫胺素、恶性肿瘤、肝脏、毒素、药物过量和药物。我们概述了乳酸水平升高的发病机制，然后深入探讨了各种病因，包括与药物相关的原因。讨论了乳酸作为诊断/预后工具的优缺点及其作为复苏临床终点的潜在用途。综述最后对升高的乳酸水平患者的管理提出了一些一般性建议。
