Lactate clearance in the acutely traumatized patient.
Lactate clearance in the acutely traumatized patient.
复制标题
急性创伤患者的乳酸清除率。
DOI：
10.1097/aln.0b013e31827334c2
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发表时间：
2012
期刊：
影响因子：
8.8
通讯作者：
Jones,AlanE
中科院分区：
文献类型：
--
作者：
Jones,AlanE
当氧气输送低于一个临界阈值，即厌氧阈值时，可供消耗的氧气量就不能满足细胞的需要。这些不平衡导致细胞缺氧，导致线粒体氧化磷酸化失败，因此能量代谢完全依赖于厌氧糖酵解1。厌氧糖酵解急剧增加细胞乳酸的产生，在长时间的细胞缺血期间，乳酸扩散到血液中。因此，循环乳酸浓度升高通常表明由于氧气输送和/或消耗不足，组织氧合普遍不足2。在本期《麻醉学》杂志上，Regnier等人发表了一项前瞻性队列分析，分析了乳酸和乳酸清除率测量在急性创伤患者中的应用。许多先前的研究已经证明乳酸盐作为休克状态的预后指标的效用2；4. 在重症监护环境中，乳酸含量的测量作为组织灌注不足的潜在指标正在得到认可5；6. 此外，乳酸筛查作为一种风险分层和预后的方法已被证明对血流动力学稳定的疑似感染患者有益5；7. 强调这些数据重要性的事实是，在病人床边进行的即时检测正变得越来越普遍8,9。
When oxygen delivery falls below a critical threshold, the anaerobic threshold, the amount of oxygen available for consumption is not able to meet the needs of cells. These imbalances result in cellular hypoxia, resulting in failure of mitochondrial oxidative phosphorylation, and as a result energy metabolism becomes wholly dependent upon anaerobic glycolysis1. Anaerobic glycolysis sharply increases the production of cellular lactate, which diffuses into the blood during prolonged cell ischemia. Elevated circulating lactate concentration thus often indicates widespread inadequate tissue oxygenation due to inadequate oxygen delivery and/or consumption 2. In this issue of Anesthesiology, Regnier et al present a prospective cohort analysis of the utility of lactate and lactate clearance measurements in the setting of the acutely traumatized patients3.Numerous previous studies have documented the utility of lactate as a prognostic indicator in shock states 2; 4. The use of lactate measurements is gaining recognition in critical care settings as a potential indicator of tissue hypoperfusion5; 6. Furthermore, lactate screening as a method of risk stratification and prognosis has been shown to be beneficial in hemodynamically stable patients with suspected infection 5; 7. Underscoring the importance of these data is the fact that point-of-care testing performed at the patient’s bedside is becoming more common 8, 9.