The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study.
The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study.
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DOI：
10.1186/cc7159
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Bakker J
中科院分区：
文献类型：
--
作者：
Jansen TC;van Bommel J;Mulder PG;Rommes JH;Schieveld SJ;Bakker J
院前监测的一个局限性是，直到患者处于危急阶段，生命体征通常才会发生变化。建议将血乳酸水平作为评估患者病情的更敏感参数。这项试点研究的目的是寻找院前乳酸水平与院内死亡率之间关系的推定证据，并纠正生命体征异常。在这项前瞻性观察性研究（n = 124）中，纳入了需要紧急救护车调度且收缩压低于 100 mmHg、呼吸频率低于 10 次或高于 29 次/分钟、或格拉斯哥昏迷量表 (GCS) 低于 14 的患者。紧急医疗服务部门的护士在到达现场 (T1) 以及到达急诊室之前或到达急诊室 (T2) 时，使用手持设备测量毛细血管或静脉乳酸水平。测量的主要结果是院内死亡率。从 T1 到 T2 的平均（标准偏差）时间为 27 (10) 分钟。非幸存者 (n = 32, 26%) 在 T1（5.3 vs 3.7 mmol/L）和 T2（5.4 vs 3.2 mmol/L）时的乳酸水平显着高于幸存者。与乳酸水平低于 3.5 mmol/L 的患者相比，乳酸水平为 3.5 mmol/L 或更高的患者死亡率显着更高（T1：41 vs 12%，T2：47 vs 15%）。此外，在没有低血压的情况下，乳酸水平较高的人的死亡率也较高。在多变量 Cox 比例风险分析中，包括收缩压、心率、GCS（均在 T1）和 δ 乳酸水平（从 T1 到 T2），仅 δ 乳酸水平（风险比 (HR) = 0.20，95% 置信区间 (CI) = 0.05 至 0.76，p = 0.018）和 GCS（HR = 0.93，95% CI = 0.88 至 0.99，p = 0.022）是院内死亡率的显着独立预测因子。在一组需要紧急救护车调度的患者中，院前血乳酸水平与院内死亡率相关，并且提供的预后信息优于患者生命体征提供的信息。在乳酸测量的指导下，有可能早期发现隐匿性休克和院前复苏。然而，在院外环境中广泛实施乳酸测量之前，需要进行外部验证。
A limitation of pre-hospital monitoring is that vital signs often do not change until a patient is in a critical stage. Blood lactate levels are suggested as a more sensitive parameter to evaluate a patient's condition. The aim of this pilot study was to find presumptive evidence for a relation between pre-hospital lactate levels and in-hospital mortality, corrected for vital sign abnormalities. In this prospective observational study (n = 124), patients who required urgent ambulance dispatching and had a systolic blood pressure below 100 mmHg, a respiratory rate less than 10 or more than 29 breaths/minute, or a Glasgow Coma Scale (GCS) below 14 were enrolled. Nurses from Emergency Medical Services measured capillary or venous lactate levels using a hand-held device on arrival at the scene (T1) and just before or on arrival at the emergency department (T2). The primary outcome measured was in-hospital mortality. The average (standard deviation) time from T1 to T2 was 27 (10) minutes. Non-survivors (n = 32, 26%) had significantly higher lactate levels than survivors at T1 (5.3 vs 3.7 mmol/L) and at T2 (5.4 vs 3.2 mmol/L). Mortality was significantly higher in patients with lactate levels of 3.5 mmol/L or higher compared with those with lactate levels below 3.5 mmol/L (T1: 41 vs 12% and T2: 47 vs 15%). Also in the absence of hypotension, mortality was higher in those with higher lactate levels. In a multivariable Cox proportional hazard analysis including systolic blood pressure, heart rate, GCS (all at T1) and delta lactate level (from T1 to T2), only delta lactate level (hazard ratio (HR) = 0.20, 95% confidence interval (CI) = 0.05 to 0.76, p = 0.018) and GCS (HR = 0.93, 95% CI = 0.88 to 0.99, p = 0.022) were significant independent predictors of in-hospital mortality. In a cohort of patients that required urgent ambulance dispatching, pre-hospital blood lactate levels were associated with in-hospital mortality and provided prognostic information superior to that provided by the patient's vital signs. There is potential for early detection of occult shock and pre-hospital resuscitation guided by lactate measurement. However, external validation is required before widespread implementation of lactate measurement in the out-of-hospital setting.
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影响因子：
2.8
作者：
Ander, DS;Jaggi, M;Gryzbowski, M
通讯作者：
Gryzbowski, M
影响因子：
3.6
作者：
RADY, MY;RIVERS, EP;NOWAK, RM
通讯作者：
NOWAK, RM
影响因子：
15.1
作者：
Chytra, Ivan;Pradl, Richard;Zidkova, Alexandra
通讯作者：
Zidkova, Alexandra
影响因子：
8.8
作者：
Nguyen, HB;Rivers, EP;Tomlanovich, MC
通讯作者：
Tomlanovich, MC
影响因子：
3.8
作者：
Fauchère, JC;Bauschatz, AS;Bucher, HU
通讯作者：
Bucher, HU