Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University Medical College, Qingdao, Shandong Province, 266000, China.
Crit Care. 2017 Feb 16;21(1):33. doi: 10.1186/s13054-017-1617-1.
Setting lactate kinetics at >30% might improve the clinical outcomes of patients with sepsis-associated hyperlactatemia. The aim of this study was to explore the outcome benefits of stepwise lactate kinetics vs central venous oxygen saturation (ScvO)-oriented hemodynamic therapy at 6 h as the protocol goal during early resuscitation.
The relevant parameters and adverse events after different targets in 360 randomly assigned patients with sepsis-associated hyperlactatemia were recorded and compared.
Heart rate (HR) at 48 h in the ScvO group was higher than in the lactate kinetics group (105 ± 19 bpm vs 99 ± 20 bpm, P = 0.040). The liquid balance at 4 h, 12 h, and 24 h in the lactate kinetics group was larger than in the ScvO group (1535 (1271-1778) ml vs 826 (631-1219) ml, P < 0.001; 1688 (1173-1923) ml vs 1277 (962 - 1588) ml, P <0.001; and 1510 (904-2087) ml vs 1236 (740-1808) ml, P = 0.005), respectively. Mortality was higher in the ScvO group (27.9% vs 18.3%, P = 0.033), but there was no significant difference between the two groups in the length of stay in the ICU or mechanical ventilation. In terms of new onset organ dysfunction, there was a significant difference between the two groups in total bilirubin at 48 h and 72 h. Based on the 60-day survival curves, there was significantly more mortality in the ScvO group than in the lactate kinetics group (X = 4.133, P = 0.042). In addition, fewer adverse events occurred in the lactate kinetics group.
Stepwise lactate kinetics-oriented hemodynamic therapy can reduce mortality in patients with sepsis-associated hyperlactatemia compared with ScvO-oriented therapy.
National Institutes of Health Clinical Trials Registry, NCT02566460 . Registered on 26 September 2015.
将乳酸动力学设定为>30%可能会改善脓毒症相关高乳酸血症患者的临床结局。本研究旨在探讨在早期复苏期间以 6 小时为目标的逐步乳酸动力学与中心静脉血氧饱和度（ScvO）导向的血流动力学治疗在 6 小时时的预后获益。
记录并比较了 360 例随机分配的脓毒症相关高乳酸血症患者在不同目标下的相关参数和不良事件。
ScvO 组在 48 小时时的心率（HR）高于乳酸动力学组（105±19bpm 比 99±20bpm，P=0.040）。乳酸动力学组在 4 小时、12 小时和 24 小时的液体平衡量大于 ScvO 组（1535（1271-1778）ml 比 826（631-1219）ml，P<0.001；1688（1173-1923）ml 比 1277（962-1588）ml，P<0.001；1510（904-2087）ml 比 1236（740-1808）ml，P=0.005）。ScvO 组死亡率较高（27.9%比 18.3%，P=0.033），但两组 ICU 或机械通气时间的差异无统计学意义。在新发器官功能障碍方面，两组在 48 小时和 72 小时的总胆红素方面存在显著差异。基于 60 天生存曲线，ScvO 组的死亡率明显高于乳酸动力学组（X ²=4.133，P=0.042）。此外，乳酸动力学组不良事件发生率较低。
与 ScvO 导向治疗相比，逐步乳酸动力学导向的血流动力学治疗可降低脓毒症相关高乳酸血症患者的死亡率。
美国国立卫生研究院临床试验注册处，NCT02566460。于 2015 年 9 月 26 日注册。
