Rabbat A, Laaban J P, Boussairi A, Rochemaure J
Service de Pneumologie et Réanimation Médicale, Hôtel-Dieu de Paris, France.
Intensive Care Med. 1998 Apr;24(4):304-12. doi: 10.1007/s001340050572.
To evaluate arterial lactate levels during treatment of acute severe asthma (ASA) and the prognostic value of arterial hyperlactatemia in ASA.
Prospective study.
A respiratory intensive care unit (ICU) of a university hospital.
29 consecutive patients admitted to the ICU for ASA not intubated on admission and with a peak expiratory flow (PEF) < 150 l/min or an arterial carbondioxide tension (PaCO2) > 40 mm Hg. All patients received standardized treatment during the first 24 h including i.v. and nebulized salbutamol, i.v. theophylline, and dexamethasone.
Arterial lactate levels were serially measured by an enzymatic method during the first 24 h following admission. On admission, the mean arterial lactate level was 3.1 +/- 0.38 mmol/l (range 1.1-10.4); 17 patients (59%) had arterial hyperlactatemia with a lactate level > 2 mmol/l. No difference was found in lactate levels between patients with progressively worsening asthma and those with an acute onset of severe asthma. No correlation was found between arterial lactate levels on admission, on the one hand, and respiratory rate (RR), heart rate, PEF, pH, PaCO2, arterial oxygen tension, potassium, phosphorus, creatine kinase, or transaminase values on admission, on the other hand. All patients developed an important but transient increase in arterial lactate levels during treatment, with a peak at 7.72 +/- 0.46 mmol/l and a mean elevation of 4.62 +/- 0.45 mmol/l (range 0.4-12.1), from the initial admission value contrasting with a significant clinical improvement assessed by RR, PEF, and arterial blood gas parameters.
This study suggests that, in ASA, arterial hyperlactatemia is frequently present on admission to the ICU. Delayed hyperlactatemia is a constant finding during treatment of ASA. Initial or delayed hyperlactatemia seems of no prognostic value because none of the patients required mechanical ventilation. The effects of therapy for acute asthma on lactate metabolism still need to be studied.
评估急性重症哮喘（ASA）治疗期间的动脉血乳酸水平以及动脉血高乳酸血症在ASA中的预后价值。
前瞻性研究。
一所大学医院的呼吸重症监护病房（ICU）。
29例因ASA连续入住ICU的患者，入院时未插管，呼气峰值流速（PEF）<150升/分钟或动脉血二氧化碳分压（PaCO2）>40毫米汞柱。所有患者在最初24小时内接受标准化治疗，包括静脉注射和雾化沙丁胺醇、静脉注射氨茶碱和地塞米松。
入院后24小时内通过酶法连续测量动脉血乳酸水平。入院时，平均动脉血乳酸水平为3.1±0.38毫摩尔/升（范围1.1 - 10.4）；17例患者（59%）存在动脉血高乳酸血症，乳酸水平>2毫摩尔/升。哮喘进行性加重患者与急性重症哮喘发作患者的乳酸水平无差异。一方面，入院时的动脉血乳酸水平与另一方面的呼吸频率（RR）、心率、PEF、pH值、PaCO2、动脉血氧分压、钾、磷、肌酸激酶或转氨酶值之间未发现相关性。所有患者在治疗期间动脉血乳酸水平均出现重要但短暂的升高，峰值为7.72±0.46毫摩尔/升，平均升高4.62±0.45毫摩尔/升（范围0.4 - 12.1），与入院初始值相比，而通过RR、PEF和动脉血气参数评估显示临床有显著改善。
本研究表明，在ASA中，入住ICU时经常存在动脉血高乳酸血症。延迟性高乳酸血症是ASA治疗期间的常见表现。初始或延迟性高乳酸血症似乎没有预后价值，因为没有患者需要机械通气。急性哮喘治疗对乳酸代谢的影响仍需研究。
