Mikulaschek A, Henry S M, Donovan R, Scalea T M
State University of New York Health Science Center at Brooklyn, Kings County Hospital Center, USA.
J Trauma. 1996 Feb;40(2):218-22; discussion 222-4. doi: 10.1097/00005373-199602000-00008.
The inability to normalize lactate predicts death after trauma, but lactate may not be immediately available in every center. We postulated that, in a normal acid-base environment, lactate would correlate with the anion gap and the base excess of an arterial blood gas.
We studied 52 consecutive, invasively monitored patients with trauma admitted directly to the intensive care unit (ICU) from the emergency department or operating room in our level I center to determine whether base excess and anion gap could predict lactate. Lactate, base excess, and anion gap were recorded upon admission to the ICU and 8, 16, 24, 36, and 48 hours after admission. Correlation coefficients (r2) were calculated for the total patients, the 43 survivors, and the nine non-survivors.
Serum lactate was significantly higher in nonsurvivors at 16 hours after post ICU admission (4.0 +/- 1.69 vs. 2.84 +/- 1.49, p < 0.05), and this trend persisted; the greatest difference was seen at 48 hours after admission (2.92 +/- 1.47 vs. 1.76 +/- 0.57, p < 0.001). There were no differences in base excess or anion gap between survivors and nonsurvivors. We found no consistent correlation between lactate versus anion gap, lactate versus base excess, or anion gap versus base excess.
There is no correlation between lactate, base excess, and anion gap after initial resuscitation. Neither anion gap nor base excess was capable of predicting lactate; therefore, lactate must be directly measured. The lack of correlation of anion gap with base excess or lactate suggests the presence of unmeasured anions, an impairment in acid-base regulation after injury and resuscitation, or both.
创伤后乳酸水平无法恢复正常预示着患者死亡，但并非每个中心都能立即检测乳酸水平。我们推测，在正常酸碱环境下，乳酸水平与动脉血气分析中的阴离子间隙和碱剩余相关。
我们对52例从急诊科或手术室直接收入我院一级重症监护病房（ICU）并接受有创监测的创伤患者进行了研究，以确定碱剩余和阴离子间隙是否能够预测乳酸水平。在收入ICU时以及收入后8、16、24、36和48小时记录乳酸水平、碱剩余和阴离子间隙。计算所有患者、43例存活患者和9例死亡患者的相关系数（r2）。
死亡患者在收入ICU后16小时的血清乳酸水平显著高于存活患者（4.0±１.69 vs. 2.84±1.49，p＜0.05），且这一趋势持续存在；入院后48小时差异最为显著（2.92±1.47 vs. 1.76±0.57，p＜0.001）。存活患者和死亡患者之间的碱剩余或阴离子间隙没有差异。我们发现乳酸与阴离子间隙、乳酸与碱剩余或阴离子间隙与碱剩余之间均无一致的相关性。
初始复苏后，乳酸水平、碱剩余和阴离子间隙之间无相关性。阴离子间隙和碱剩余均无法预测乳酸水平；因此，必须直接检测乳酸水平。阴离子间隙与碱剩余或乳酸缺乏相关性，提示存在未测定的阴离子、损伤和复苏后酸碱调节受损，或两者兼而有之。
