乳酸——反映组织与器官低灌注的良好指标

doi:10.3969/j.issn.1002-1949.2018.12.004

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摘要过去人们认为血压降低是休克的主要标志，随着研究的不断深入，目前认为休克的实质是微循环障碍和衰竭导致的组织低灌注和细胞缺氧，并继发多器官功能障碍综合征 (MODS)甚至多器官功能衰竭(MOF)的序贯性事件。血压并非诊断休克的敏感指标，临床常见虽然生命体征稳定但已经出现组织灌注不足的早期休克患者。目前，许多临床医生仍以血压下降作为休克的诊断标准，往往贻误休克的最佳复苏时机，为后续救治带来困难。如何在休克早期循环状态尚且稳定的情况下早期发现组织器官低灌注的存在并开始积极的复苏治疗，给临床医生带来挑战。

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	温伟
	张新超

关键词 ：血乳酸, 脓毒性休克, 组织灌注, 酸中毒

通讯作者: 张新超（1962-），男，博士，主任医师，教授，硕士生导师，E-mail：xinchaoz@163.com。

作者简介: 温伟（1972-），男，硕士，主任医师，科副主任。

引用本文:

温伟，张新超. 乳酸——反映组织与器官低灌注的良好指标[J]. 中国急救医学, 2018, 38(12): 1039-1041.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.12.004 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I12/1039

［1］肖海鹏，杨惠玲．临床病理生理学［M］．北京：人民卫生出版社， 2009：54-55. ［2］Antonelli M， Levy M， Andrews PJ， et al． Hemodynamic monitoring in shock and implications for management． International Consensus conference， Paris． France， 27-28 April 2006［J］． Intensive Care Med, 2007， 33(4)：575-590. ［3］Vincent JL, De Backer D. Circulatory shock［J］. N Engl J Med, 2013, 369(18):1726-1734. ［4］Cecconi M, DeBacker D， Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine［J］． Intensive Care Med, 2014, 40(12):1795-1815.［5］Vallée F， Vallet B， Mathe O, et al. Central venous-to-arterial carbon dioxide difference：an additional target for goal direted therapy inseptic shock［J］．Intenssive Care Med, 2008, 34(12):2218-2225.  ［6］Broder G, Weil MH. Excess lactate: an index of reversibility of shock in human patients［J］. Science, 1964, 143(3613):1457-1459. ［7］Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock 2012［J］. Intensive Care Med, 2013, 39(2):165-228. ［8］Singer M, Deutschman CS, Seymour CW, et al. The Third internationalconsensus Definitions for Sepsis and Septic Shock(Sepsis-3)［J］. JAMA, 2016, 315(8):801-810.  ［9］周爱儒．生物化学［M］.北京：人民卫生出版社， 2004:102. ［10］Gladden LB． Lactate uptake by keletal muscle［J］． Exer Sport Sci Rev, 1998，17(1)：115-155. ［11］李春盛．乳酸与危重病［J］．急诊医学， 1999，8(2)：127-129. ［12］Salak N， Pajk W， Knotzer H， et al． Effects of epinephrine on intestinal oxygen supply and muosal tissue oxygen tension in pigs［J］． Crit Care Med, 2001， 29(2)：367-373． ［13］Levy B， Gibot S， Franck P， et al． Relation between muscle Na+- K+-ATPase activity and raised lactate concentrations in septic shock：a prospective study［J］． Lancet, 2005， 365(9462)：871-875.  ［14］Levy B， Desebbe O， Montemont C， et al． Increased aerobic glycolysis through beta 2 stimulation is a common mechanism involved in lactate formation during shock states［J］. Shock, 2008， 30(4):417-421. ［15］Standage SW, Wong HR. Biomarkers for pediatric sepsis and septic shock［J］. Expert Rev Anti Infect Ther, 2011, 9(1):71-79. ［16］Contenti J, Occelli C, Corraze H, et al. Long-term β-blocker therapy decrease blood lactate concentration in severely septic patients［J］. Crit Care Med, 2015, 43(12):2616-2622. ［17］Levraut J, Ciebiera JP, Chave S, et al. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction［J］. Am J Respir Crit Care Med, 1998, 157(4Pt1):1021-1026. ［18］Trzeciak S， Dellinger RP， Chansky ME， et al． Serum lactate as a predictor of mortality in patients with infection［J］. Intensive Care Med, 2007， 33（6）：970-977. ［19］RimachiR, Bruzzi de Carvahlo F, Orellano-Jimenez C， et al. Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock［J］. Anaesth Intensive Care, 2012, 40(3):427-432. ［20］Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock［J］. N Engl J Med, 2015, 372(14):1301-1311. ［21］Gu WJ, Zhang Z, Baker J. Early lactate clearance-guided therapy in patients with sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials［J］. Intensive Care Med, 2015, 41(10):1862-1863. ［22］Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion:results from the surviving sepsis campaign database［J］. Crit Care Med, 2015, 43(3):567-573. ［23］Song JE, Kim MH, Jeong WY,et al.Mortality Risk Factors for Patients with Septic Shock after Implementation of the Surviving Sepsis Campaign Bundles［J］. Infect Chemother, 2016, 48(3):199-208. ［24］Nguyen HB， Rivers EP， Knoblich BP， et al． Early lactate clearance is associated with improved outcome in severe sepsis and septic shock［J］． Crit Care Med, 2004, 32(8):1637-1642. ［25］Jones AE. Lactate clearance for assessing response to resuscitation in severe sepsis［J］. Acad Emerg Med, 2013, 20(8):844-847. ［26］中华医学会重症医学分会. 低血容量休克复苏指南(2007)［J］. 中国实用外科杂志， 2007, 27（8）：581-587. ［27］Alegria L, Vera M, Dreyse J, et al. A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients: a proof-of-concept study［J］. Ann Intensive Care, 2017, 7(1):29.