Experimental and Clinical Studies on Lactate and Pyruvate as Indicators of the Severity of Acute Circulatory Failure (Shock)
Experimental and Clinical Studies on Lactate and Pyruvate as Indicators of the Severity of Acute Circulatory Failure (Shock)
复制标题
乳酸和丙酮酸作为急性循环衰竭（休克）严重程度指标的实验和临床研究
作者：
M. Weil;A. Afifi
本实验采用Wistar大鼠失血性休克模型，对实验性和临床休克状态下动脉血中乳酸（L）和丙酮酸（P）含量的增加及其作为缺氧和不可逆损伤的指标进行了实验性研究。在4小时出血期间，大鼠的耗氧量降低至对照值的约40%，pH值从7.39降低至7.08，同时观察到L从0.80 mM增加至6.06 mM，P从0.07 mM增加至0.18 mM。累积氧债与logL相关（r = 0.50; P < 0.0005），两者均与生存率显著相关。累积氧债和生存率的相关性，无论是与P和乳酸/丙酮酸比（L/P）和过量乳酸（XL）的计算值，没有更高的幅度。偏相关分析表明，无论是测量P还是L/P或XL的计算都不能提高预测性，在142例出现循环休克临床表现的患者中，其中62例存活，80例死亡，存活者和死亡者之间的最佳经验判别是通过测量L提供的，只有11%的时间失败。判别函数分析证实了这一点，其中基于L的错误分类的百分比概率为12%，而L/P的错误分类概率增加到21%，XL的错误分类概率增加到19%。XL和L/P与L的组合未能改善辨别力。在这一系列患者中，L是一个敏感的预测因子;当L从2.1mM增加到8.0mM时，估计的存活概率从90%降低到10%，这些研究证实L单独作为可靠的指示剂，但既不能测量P，也不能计算L/P或XL被证明可以提高L作为累积氧债的量度的可靠性或其作为休克状态期间存活率的衡量指标的价值。
The increase in lactate (L) and pyruvate (P) content of arterial blood during experimental and clinical shock states and the extent to which such increases serve as measures of oxygen deficit and irreversible injury were investigated on an empirical basis.A standardized method for production of hemorrhagic shock in the Wistar rat was employed. During a 4-hour bleeding period, oxygen consumption of the rat was reduced to approximately 40% of control value, pH was reduced from 7.39 to 7.08, and a concurrent increase in L from 0.80 to 6.06 mM and in P from 0.07 to 0.18 mM were observed. Cumulative oxygen debt correlated with log L (r = 0.50; P < 0.0005) and both were significantly related to survival. Correlation of cumulative oxygen debt and survival, both with P and with computed values of the lactate pyruvate ratio (L/P) and excess lactate (XL), were of no higher magnitude. Partial correlation analysis demonstrated that neither the measurement of P nor the computation of L/P or XL improved predictability.In 142 patients who presented with clinical manifestation of circulatory shock and of whom 62 survived and 80 died, the best empirical discrimination between survivors and those who died was provided by measurement of L, which failed only 11% of the time. This was confirmed by discriminant function analysis in which the percentage probability of misclassification based on L was 12% whereas this probability increased to 21% with L/P and 19% with XL. The combination of XL and L/P with L failed to improve discrimination. In this series of patients, L served as a sensitive predictor; as L increased from 2.1 to 8.0 mM, the estimated probability of survival decreased from 90 to 10%.These studies corroborate that L alone serves as a reliable indicator, but neither the measurement of P nor the computation of L/P or XL was shown to improve either the reliability of L as a measure of cumulative oxygen debt or its value as a prognosticator of survival during shock states.