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題名 | Using Blood Lactate to Predict Prognosis in Emergency Shock Patients=測定血中乳酸濃度對預測急診病患預後之探討 |
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作 者 | 陳維恭; 鄭宜昌; 黃正金; 林順木; 黃金財; 林炯璁; 莊錦銘; | 書刊名 | 中臺灣醫學科學雜誌 |
卷期 | 6:3 2001.09[民90.09] |
頁次 | 頁133-138 |
分類號 | 415.214 |
關鍵詞 | 急診; 乳酸; 休克; Emergency department; Lactate; Shock; |
語文 | 英文(English) |
中文摘要 | 背景:乳酸通常會由於組織灌流不足、缺氧或重度疾病而產生,本研究的目的是探究在急診室偵測休克病患血液乳酸濃度可否做為預測其預後的工具。方法:進入本研究的病患條件是:1)進入急診時伴隨有休克症候群;2)急救前血液乳酸濃度出現異常值(>19.6mg/dL) 的病患。這些病患於接受急救後4小時或者是在要送入開刀房、加護病房或一般病房前,均再次接受血液乳酸濃度的測定。結果:本研究共收集75位病患於急救前有不正常的血液乳酸濃度(>19.6 mg/dL)。死亡的病患急救後的血液乳酸濃度高於存活的病患 (74.4 ± 72.1 vs 27.0 ± 11.1 mg/dL,P<0.0001)。除此外,當急救前的血液乳酸濃度大於100 mg/dL 時其死亡率也比小於100 mg/dL 為高(87% vs 43%,P<0.005),急救後的血液酸濃度若大於50 mg/dL時其死亡率也比小於50 mg/dL為高(100% vs 36%,P<0.0001),而急救前及急救後的血液乳酸濃度的清除量若大於20 mg/dL,其死亡率也比小於20 mg/dL為高(100% vs 47%,P<0.005)。結論:測定乳酸濃度及其變化可已協助急診醫師在急診室預測病患的預後。急救後乳酸濃度的測定在預測病患的預後上比急救前有價值。 |
英文摘要 | Background:Lactic acidosis is frequently caused by systemic hypoperfusion, tissue hypoxia and the severity of shock. The purpose of this study was to investigate whether blood lactate concentration is a useful prognostic parameter in patients with shock in the emergency department (ED). Methods:The criteria for patient selection were 1)arrival at ED with shock syndrome, 2)blood lactate (BLC1)>19.6 mg/dL prior to resuscitation. All patients were monitored of blood lactate (BLC2)after resuscitation over a period of four hours prior to being sent to the operation room, intensive care unit or ordinary ward. Results:Seventy-five shock patients had abnormal blood lactate levels (BLC1>19.6 mg/dL) before resuscitation. Patients who died (mortality group) had significantly higher BLC2 levels (74.4 ± 72.1 vs 27.0 ± 11.1 mg/dL, P<0.0001) than patients who survived (survival group). In addition, there was a significantly higher mortality rate in patients with blood lactate concentrations (BLC1)>100 mg/dL than patients with blood lactate concentrations (BLC2) ≦100 mg/dL (87% vs 43%, P<0.005). Patients with blood lactate conentrations (BLC2)>50 mg/dL had a higher mortality rate than patients with blood lactate concentrations (BLC2) ≦50 mg/dL (100% vs 36%, P<0.0001). Patients with changes in blood lactate levels (BLC2-BLC1)>20 mg/dL had a higher rate of mortality than those with a change of ≦ 20 mg/dL (n=66) (100% vs 47%, p<0.005). Conclusions: Blood lactate and its learance may help emergency physicians predict the prognosis of shock patients in the ED. The detection of the changes in blood lactate concentrations after resuscitation is more valuable than before resuscitation. |
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