对于阴离子间隙和血清碳酸氢盐正常的患者，血清乳酸水平是否必要？
Is serum lactate necessary in patients with normal anion gap and serum bicarbonate?
作者信息
Aronovich Daniel, Trotter Maykel, Rivera Cynthia, Dalley Michael, Farcy David, Betancourt Michel, Howard Lydia, Licciardi Sharon, Cubeddu Luigi, Goldszer Robert
机构信息
Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida.
Mount Sinai Medical Center, Department of Internal Medicine, Miami Beach, Florida.
出版信息
West J Emerg Med. 2015 May;16(3):364-6. doi: 10.5811/westjem.2015.2.23906. Epub 2015 Apr 2.
INTRODUCTION
There has been an increase in patients having serum lactate drawn in emergency situations. The objective of this study was to determine whether or not it was necessary to obtain a lactate level in patients with a normal serum bicarbonate level and anion gap.
METHODS
This is a retrospective chart review evaluation of 304 patients who had serum lactate and electrolytes measured in an emergency setting in one academic medical center.
RESULTS
In 66 patients who had elevated serum lactate (>2.2mmol/L), 45 (68%) patients had normal serum bicarbonate (SB) (greater than 21 mmol/L). Normal anion gap (AG) (normal range <16 mEq/l) was found in 51 of the 66 patients (77%).
CONCLUSION
We found that among patients with elevated serum lactate, 77% had a normal anion gap and 68% had normal serum bicarbonate. We conclude serum lactate should be drawn based on clinical suspicion of anaerobic tissue metabolism independent of serum bicarbonate or anion gap values.
引言
急诊情况下进行血清乳酸检测的患者数量有所增加。本研究的目的是确定对于血清碳酸氢盐水平和阴离子间隙正常的患者，是否有必要检测乳酸水平。
方法
这是一项对在一家学术医疗中心的急诊环境中进行血清乳酸和电解质检测的304例患者的回顾性病历审查评估。
结果
在66例血清乳酸升高（>2.2mmol/L）的患者中，45例（68%）患者的血清碳酸氢盐（SB）正常（大于21mmol/L）。66例患者中有51例（77%）的阴离子间隙（AG）正常（正常范围<16mEq/l）。
结论
我们发现，在血清乳酸升高的患者中，77%的患者阴离子间隙正常，68%的患者血清碳酸氢盐正常。我们得出结论，应根据对无氧组织代谢的临床怀疑来检测血清乳酸，而不依赖于血清碳酸氢盐或阴离子间隙值。
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