Sheikh A, Fleisher G, Delgado Paredes C, Caputo G, Schaible D, Egler J, Swedlow D
Crit Care Med. 1986 Nov;14(11):970-3. doi: 10.1097/00003246-198611000-00012.
Lactic acidosis is seen frequently after severe anoxia and circulatory failure. Because dichloroacetate (DCA) has been shown to be effective in the treatment of lactic acidosis, we studied its effect on lactate levels and pH in arterial and sagittal sinus blood specimens in a pediatric canine model of anoxic cardiac arrest followed by CPR. Lactate levels rose steadily in all puppies receiving DCA alone (group 1), DCA plus bicarbonate (group 2), bicarbonate alone (group 3), or neither drug (group 4). Arterial and sagittal-sinus lactate levels were in the range of 2 mmol/L during the baseline period, 6 mmol/L after anoxic arrest, and 10 mmol/L after 20 min of CPR. Bicarbonate, but not DCA, significantly raised arterial pH. Neither drug reversed the progression of acidosis in the sagittal sinus; mean pH ranged from 6.85 to 6.92 among the four groups after 20 min of CPR. We speculate that DCA did not decrease lactate levels or raise the pH in either the peripheral circulation or the CNS (sagittal sinus) because of poor perfusion achieved during closed-chest cardiac compression.
乳酸酸中毒在严重缺氧和循环衰竭后很常见。由于二氯乙酸（DCA）已被证明对乳酸酸中毒的治疗有效，我们在一个小儿犬缺氧性心脏骤停后进行心肺复苏（CPR）的模型中，研究了其对动脉血和矢状窦血标本中乳酸水平及pH值的影响。在所有单独接受DCA（第1组）、DCA加碳酸氢盐（第2组）、单独接受碳酸氢盐（第3组）或两种药物都未接受（第4组）的幼犬中，乳酸水平均稳步上升。在基线期，动脉血和矢状窦乳酸水平在2 mmol/L左右，缺氧性心脏骤停后为6 mmol/L，CPR 20分钟后为10 mmol/L。碳酸氢盐可显著提高动脉血pH值，但DCA不能。两种药物均未逆转矢状窦酸中毒的进展；CPR 20分钟后，四组的平均pH值在6.85至6.92之间。我们推测，由于在闭胸心脏按压期间实现的灌注不良，DCA未能降低外周循环或中枢神经系统（矢状窦）中的乳酸水平或提高pH值。
