Ben-Hamouda Nawfel, Haesler Laurence, Liaudet Lucas
Service de médecine intensive adulte et Centre des brûlés, CHUV, 1011 Lausanne.
Rev Med Suisse. 2013 Dec 11;9(410):2335-40.
Hyperlactatemia is associated with an ominous prognosis in critical illness and must be rapidly detected. Lactate is produced by glycolysis through reduction of pyruvate, itself oxidized in the mitochondria. It is transported to the liver and converted to glucose through gluconeogenesis (Cori's cycle). Hyperlactatemia can result from excessive production or reduced clearance. Excess production can occur in aerobic conditions, following an increase in pyruvate generation, or in anaerobic conditions, due to impaired pyruvate oxidation. Reduced lactate clearance occurs as a result of liver hypoperfusion or hepatic failure. Lactate/pyruvate ratio, as well as the concomitant existence of metabolic acidosis (lactic acidosis), help distinguish the different mechanisms leading to hyperlactatemia, which are reviewed in detail in this article.
高乳酸血症与危重症患者的不良预后相关，必须迅速检测出来。乳酸是通过糖酵解由丙酮酸还原产生的，丙酮酸本身在线粒体中被氧化。它被转运到肝脏并通过糖异生（科里循环）转化为葡萄糖。高乳酸血症可能是由于产生过多或清除减少所致。丙酮酸生成增加后，在有氧条件下或丙酮酸氧化受损导致的无氧条件下，均可发生乳酸生成过多。肝脏灌注不足或肝功能衰竭会导致乳酸清除减少。乳酸/丙酮酸比值以及代谢性酸中毒（乳酸酸中毒）的同时存在，有助于区分导致高乳酸血症的不同机制，本文将对此进行详细综述。
