Manikis P, Jankowski S, Zhang H, Kahn R J, Vincent J L
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
Am J Emerg Med. 1995 Nov;13(6):619-22. doi: 10.1016/0735-6757(95)90043-8.
To define the value of serial measurements of blood lactate levels after trauma, the present study investigated the correlation between blood lactate, mortality, and organ failure in 129 trauma patients, including 100 intensive care unit (ICU) survivors and 29 ICU fatalities. On admission, injury severity score (ISS) was higher and Glasgow coma score (GCS), revised trauma score (RTS), and trauma revised ISS (TRISS) were lower in the nonsurvivors than in the survivors. Serial arterial blood lactate levels were measured on admission and at least three times a day until normalization. Both initial lactate and highest lactate levels were higher in the nonsurvivors than in the survivors. Organ failure developed in 84 (65%) of the 129 patients. Patients with organ failure had significantly lower RTS and TRISS. Initial lactate and highest lactate levels were significantly higher in patients with organ failure than without organ failure (3.4 [0.7 to 12.7] versus 2.4 [0.4 to 7.6] mEq/L and 4.1 [0.7 to 12.7] versus 2.8 [0.4 to 8.9] mEq/L, respectively, both P < .01). The duration of hyperlactatemia averaged 2.2 days in the former but 1.0 day in the latter patients (P < .01). The data therefore indicate that not only the initial or the highest lactate value but also the duration of hyperlactatemia can be correlated with the development of organ failure. These observations stress the importance of the initial resuscitation in the prevention of organ failure. Serial blood lactate measurements are reliable indicators of morbidity and mortality after trauma.
为了确定创伤后连续测量血乳酸水平的价值，本研究调查了129例创伤患者的血乳酸水平、死亡率和器官衰竭之间的相关性，其中包括100例重症监护病房（ICU）幸存者和29例ICU死亡患者。入院时，非幸存者的损伤严重程度评分（ISS）较高，而格拉斯哥昏迷评分（GCS）、修正创伤评分（RTS）和创伤修正ISS（TRISS）低于幸存者。入院时测量动脉血乳酸水平，并每天至少测量三次，直至恢复正常。非幸存者的初始乳酸水平和最高乳酸水平均高于幸存者。129例患者中有84例（65%）发生器官衰竭。发生器官衰竭的患者RTS和TRISS显著降低。发生器官衰竭的患者初始乳酸水平和最高乳酸水平显著高于未发生器官衰竭的患者（分别为3.4[0.7至12.7]与2.4[0.4至7.6]mEq/L以及4.1[0.7至12.7]与2.8[0.4至8.9]mEq/L，均P<0.01）。高乳酸血症持续时间在前一组患者中平均为2.2天，而在后一组患者中为1.0天（P<0.01）。因此，数据表明不仅初始或最高乳酸值，而且高乳酸血症的持续时间都可能与器官衰竭的发生相关。这些观察结果强调了初始复苏在预防器官衰竭中的重要性。连续测量血乳酸是创伤后发病率和死亡率的可靠指标。
