Grayck E N, Meliones J N, Kern F H, Hansell D R, Ungerleider R M, Greeley W J
Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
Pediatrics. 1995 Nov;96(5 Pt 1):914-7.
To correlate the initial and maximal lactate levels with the occurrence of intracranial hemorrhage (ICH) and survival in patients treated with extracorporeal life support (ECLS).
Retrospective chart review.
Pediatric intensive care unit.
Eighty-two neonatal patients placed on ECLS for respiratory failure due to sepsis, meconium aspiration, or persistent pulmonary hypertension of the newborn.
The initial lactate level measured within 6 hours of initiating ECLS and the maximal lactate level measured throughout the ECLS course were collected. Lactate levels were described as mean lactate +/- SE (mM). Head ultrasound reports and survival were reviewed. Platelet counts and activated clotting times (ACTs) were examined.
The mean initial and maximal lactate levels were higher in ECLS patients who developed ICH (initial: 10 +/- 1.7 mM vs 6.4 +/- 0.8 mM, p = .05 and maximal: 12.4 +/- 2.5 mM vs 7.9 +/- 0.8 mM, p = .04). Initial and maximal lactate levels were also elevated in nonsurvivors (initial: 11.7 +/- 3 mM vs 6.4 +/- 0.7 mM, p = .01 and maximal: 14.8 +/- 3.3 mM vs 7.8 +/- 0.8 mM, P < .01). Platelet counts and ACT did not differ in patients with and without ICH.
Lactate is a useful marker for the development of ICH in ECLS patients. In addition, elevated lactates during ECLS identify a subgroup of patients with poor outcome. Prospective studies are needed to determine whether the incorporation of this information into pre-ECLS and ECLS management will decrease the occurrence of ICH and improve survival.
探讨体外生命支持（ECLS）治疗患者的初始乳酸水平和最高乳酸水平与颅内出血（ICH）发生及生存情况的相关性。
回顾性病历审查。
儿科重症监护病房。
82例因败血症、胎粪吸入或新生儿持续性肺动脉高压导致呼吸衰竭而接受ECLS治疗的新生儿患者。
收集开始ECLS治疗后6小时内测得的初始乳酸水平以及整个ECLS治疗过程中测得的最高乳酸水平。乳酸水平以平均乳酸±标准误（mM）表示。回顾头部超声报告和生存情况。检查血小板计数和活化凝血时间（ACT）。
发生ICH的ECLS患者的平均初始乳酸水平和最高乳酸水平更高（初始：10±1.7 mM对6.4±0.8 mM，p = 0.05；最高：12.4±2.5 mM对7.9±0.8 mM，p = 0.04）。非存活者的初始乳酸水平和最高乳酸水平也升高（初始：11.7±3 mM对6.4±0.7 mM，p = 0.01；最高：14.8±3.3 mM对7.8±0.8 mM，P < 0.01）。有ICH和无ICH的患者血小板计数和ACT无差异。
乳酸是ECLS患者发生ICH的有用标志物。此外，ECLS期间乳酸水平升高可识别预后不良的患者亚组。需要进行前瞻性研究以确定将该信息纳入ECLS前和ECLS管理是否会降低ICH的发生率并提高生存率。
