Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
China & State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
BMC Anesthesiol. 2021 Mar 19;21(1):86. doi: 10.1186/s12871-021-01293-x.
To investigate the optimal target e of lactate kinetics at different time during the resuscitation, the factors that influence whether the kinetics achieve the goals, and the clinical implications of different clinical phenotypes.
Patients with hyperlactatemia between May 1, 2013 and December 31, 2018 were retrospectively analyzed. Demographic data, basic organ function, hemodynamic parameters at ICU admission (T0) and at 6 h, 12 h, 24 h, 48 h, and 72 h, arterial blood lactate and blood glucose levels, cumulative clinical treatment conditions at different time points and final patient outcomes were collected.
A total of 3298 patients were enrolled, and the mortality rate was 12.2%. The cutoff values of lactate kinetics for prognosis at 6 h, 12 h, 24 h, 48 h, and 72 h were 21%, 40%, 57%, 66%, and 72%. The APACHE II score, SOFA score, heart rate (HR), and blood glucose were risk factors that correlated with whether the lactate kinetics attained the target goal. Based on the pattens of the lactate kinetics, eight clinical phenotypes were proposed. The odds ratios of death for clinical phenotypes VIII, IV, and II were 4.39, 4.2, and 5.27-fold of those of clinical phenotype I, respectively.
Stepwise recovery of lactate kinetics is an important resuscitation target for patients with hyperlactatemia. The APACHE II score, SOFA score, HR, and blood glucose were independent risk factors that influenced achievement of lactate kinetic targets. The cinical phenotypes of stepwise lactate kinetics are closely related to the prognosis.
为了研究复苏过程中不同时间乳酸动力学的最佳目标值、影响动力学目标达成的因素以及不同临床表型的临床意义。
回顾性分析 2013 年 5 月 1 日至 2018 年 12 月 31 日期间高乳酸血症患者。收集人口统计学数据、基本器官功能、入住 ICU 时（T0）和 6、12、24、48 和 72 小时的血流动力学参数、动脉血乳酸和血糖水平、不同时间点的累积临床治疗情况以及最终患者结局。
共纳入 3298 例患者，死亡率为 12.2%。乳酸动力学对 6、12、24、48 和 72 小时预后的截断值分别为 21%、40%、57%、66%和 72%。APACHE II 评分、SOFA 评分、心率（HR）和血糖是与乳酸动力学是否达到目标相关的危险因素。根据乳酸动力学模式，提出了 8 种临床表型。临床表型 VIII、IV 和 II 的死亡比值比分别为临床表型 I 的 4.39、4.2 和 5.27 倍。
乳酸动力学的逐步恢复是高乳酸血症患者复苏的重要目标。APACHE II 评分、SOFA 评分、HR 和血糖是影响乳酸动力学目标达成的独立危险因素。逐步乳酸动力学的临床表型与预后密切相关。
