Lazzeri Chiara, Valente Serafina, Chiostri Marco, Gensini Gian Franco
Chiara Lazzeri, Serafina Valente, Marco Chiostri, Gian Franco Gensini, Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy.
World J Cardiol. 2015 Aug 26;7(8):483-9. doi: 10.4330/wjc.v7.i8.483.
Lactate, as a metabolite of easy and quick assessment, has been studied over time in critically ill patients in order to evaluate its prognostic ability. The present review is focused on the prognostic role of lactate levels in acute cardiac patients (that is with acute coronary syndrome, cardiogenic shock, cardiac arrest, non including post cardiac surgery patients). In patients with ST-elevation myocardial infarction treated with mechanical revascularization, hyperlactatemia identified a subset of patients at higher risk for early death and in-hospital complications, being strictly related mainly to hemodynamic derangement. The prognostic impact of hyperlactatemia on mortality has been documented in patients with cardiogenic shock and in those with cardiac arrest even if there is no cut-off value of lactate to be associated with worse outcome or to guide resuscitation or hemodynamic management. Therapeutic hypothermia seems to affect per se lactate values which have been shown to progressively decrease during hypothermia. The mechanism(s) accounting for lactate levels during hypothemia seem to be multiple ranging from the metabolic effects of reduced temperatures to the hemodynamic effects of hypothermia (i.e., reduced need of vasopressor agents). Serial lactate measurements over time, or lactate clearance, have been reported to be clinically more reliable than lactate absolute value also in acute cardiac patients. Despite differences in study design, timing of lactate measurements and type of acute cardiac conditions (i.e., cardiogenic shock, cardiac arrest, refractory cardiac arrest), available evidence strongly suggests that higher lactate levels can be observed on admission in non-survivors and that higher lactate clearance is associated with better outcome.
乳酸作为一种易于快速评估的代谢产物，长期以来一直在危重症患者中进行研究，以评估其预后能力。本综述聚焦于乳酸水平在急性心脏疾病患者（即急性冠状动脉综合征、心源性休克、心脏骤停，不包括心脏手术后患者）中的预后作用。在接受机械血运重建治疗的ST段抬高型心肌梗死患者中，高乳酸血症确定了一组早期死亡和院内并发症风险较高的患者，这主要与血流动力学紊乱密切相关。高乳酸血症对心源性休克患者和心脏骤停患者死亡率的预后影响已得到证实，即使没有与更差预后相关或指导复苏及血流动力学管理的乳酸临界值。治疗性低温似乎本身会影响乳酸值，已证明在低温期间乳酸值会逐渐降低。低温期间乳酸水平的机制似乎是多方面的，从体温降低的代谢效应到低温的血流动力学效应（即减少血管加压药的需求）。在急性心脏疾病患者中，随着时间的推移进行系列乳酸测量或乳酸清除率，在临床上也比乳酸绝对值更可靠。尽管研究设计、乳酸测量时间和急性心脏疾病类型（即心源性休克、心脏骤停、难治性心脏骤停）存在差异，但现有证据强烈表明，非幸存者入院时乳酸水平较高，且较高的乳酸清除率与更好的预后相关。
