Brillantino A, Iacobellis F, Renzi A, Nasti R, Saldamarco L, Grillo M, Romano L, Castriconi M, Cittadini A, De Palma M, Scaglione M, Di Martino N, Grassi R, Paladino F
Emergency Department "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy.
Eur J Trauma Emerg Surg. 2018 Apr;44(2):265-272. doi: 10.1007/s00068-017-0805-7. Epub 2017 Jun 13.
The role of serum lactate measurement in patients with intestinal ischemia still remains unclear. The aim of this study was to prospectively evaluate the diagnostic performance of arterial blood gas lactate concentrations in the patients with acute mesenteric ischemia and its different forms.
All the patients reporting abdominal pain associated with risk factors for mesenteric ischemia underwent arterial blood gas and contrast enhanced abdominal computer tomography (CT).
At CT, 201 patients (70.7%) showed a nonischemic disease (group 1) and 83 patients (29.2%) showed findings of mesenteric ischemia. Out of these, 35 patients (42.1%) showed bowel ischemia secondary to non vascular causes (group 2) and 48 (57.8%) had a vascular intestinal ischemia (group 3). Out of these, 20 showed small bowel arterial occlusion (group 3a), 13 a small bowel nonocclusive ischemia (group 3b), 7 a venous small bowel occlusion (group 3c) and 8 showed isolated colonic ischemia (group 3d). The median lactate serum level was significantly higher in patients with vascular ischemia if compared with patients with nonischemic disease and secondary mesenteric ischemia (p < 0.0001; Kruskal-Wallis test). The areas under ROC curves for the lactate serum levels in the groups 2, 3, 3a, 3b, 3c and 3d were, respectively, 0.61, 0.85, 0.93, 0.93, 0.68 and 0.67.
Arterial blood gas lactate levels seem to show good diagnostic accuracy in diagnosing small bowel arterial and nonocclusive ischemia and poor accuracy in diagnosing secondary mesenteric ischemia, small bowel venous ischemia and ischemic colitis.
血清乳酸测定在肠缺血患者中的作用仍不明确。本研究的目的是前瞻性评估动脉血气乳酸浓度在急性肠系膜缺血患者及其不同类型中的诊断性能。
所有报告有腹痛且伴有肠系膜缺血危险因素的患者均接受了动脉血气分析和腹部增强计算机断层扫描（CT）。
在CT检查中，201例患者（70.7%）显示为非缺血性疾病（第1组），83例患者（29.2%）显示有肠系膜缺血表现。其中，35例患者（42.1%）显示为非血管性原因导致的肠缺血（第2组），48例（57.8%）患有血管性肠缺血（第3组）。其中，20例显示小肠动脉闭塞（第3a组），13例为小肠非闭塞性缺血（第3b组），7例为小肠静脉闭塞（第3c组），8例显示孤立性结肠缺血（第3d组）。与非缺血性疾病和继发性肠系膜缺血患者相比，血管性缺血患者的血清乳酸中位数水平显著更高（p < 0.0001；Kruskal-Wallis检验）。第2组、第3组、第3a组、第3b组、第3c组和第3d组血清乳酸水平的ROC曲线下面积分别为0.61、0.85、0.93、0.93、0.68和0.67。
动脉血气乳酸水平在诊断小肠动脉和非闭塞性缺血方面似乎具有良好的诊断准确性，而在诊断继发性肠系膜缺血、小肠静脉缺血和缺血性结肠炎方面准确性较差。
