摘要
目的：寻找并评价组织缺氧的代谢指标，并探讨全身炎性反应综合征（ＳＩＲＳ）患者动脉血乳酸（ＡＢＬ）与低血容量的关系。方法：对我院ＩＣＵ的１１例ＳＩＲＳ患者进行了有关代谢指标和氧相关指标的测定，主要包括基础状态和扩容后的动脉血乳酸（ＡＢＬ）、动脉血丙酮酸（ＡＢＰ）、乳酸／丙酮酸比值（Ｌ／Ｐ）、氧输送（ＤＯ２）、氧消耗（ＶＯ２）和氧提取率（Ｏ２ＥＲ）。结果：ＳＩＲＳ患者临床上未出现明显休克征象而仅有低血容量状态时即可出现ＡＢＬ〔（３．３±２．６）ｍｍｏｌ／Ｌ〕、ＡＢＰ〔（０．１９±０．０８）ｍｍｏｌ／Ｌ）〕和Ｌ／Ｐ（１８±８）增高。高乳酸血症ＳＩＲＳ患者在扩容后ＶＯ２和ＤＯ２显著增高〔ＶＯ２：（１２２±３８）ｍｌ·ｍ－２／ｍｉｎ比（１８６±６８）ｍｌ·ｍ－２／ｍｉｎ；ＤＯ２：（４３４±１０３）ｍｌ·ｍ－２／ｍｉｎ比（５９９±１４９）ｍｌ·ｍ－２／ｍｉｎ，Ｐ均＜０．０５〕；且ＶＯ２和ＤＯ２呈显著线性正相关（Ｙ＝０．３６Ｘ－３２．００，ｒ＝０．８６３２，Ｐ＜０．０５），而ＡＢＬ、ＡＢＰ和Ｌ／Ｐ在扩容前后并无显著性变化。结论：ＳＩＲＳ患者在未出现休克的低血容量状态时，即可出现ＡＢＬ、ＡＢＰ和Ｌ／Ｐ增高。通过扩容，在ＤＯ?
Objective:To determine the relationship between metabolic varibables and oxygenderived variables which are used to evaluate tissue hypoxia in patients with systemic inflammatory response syndrome (SIRS).Methods:We have prospectively evaluated 11 patients with SIRS by following variables which were measured and calculated before and after fluid loading,including arterial blood lactate (ABL),arterial blood pyruvate (ABP),lactate/pyruvate ratio (L/P),oxygen delivery (O 2),oxygen consumption (O 2),oxygen extraction (O 2ER).Results:We found all the patients had elevated levels of ABL (3 3±2 6) mmol/L ,ABP (0 19±0 08)mmol/L and L/P(18±8) without signs of shock.In these patients,fluid loading led to significant increases in both O 2 (434±103)ml·m -2 /min vs.(599±149)ml·m -2 /min and O 2 (122±38)ml·m -2 /min vs.(186±68)ml·m -2 /min ,both P <0 05 .For all 22 observations,there was a significant linear relationship between O 2 and O 2 ( Y=0 36X -32 00,r=0 863 2,P<0 05 ).There were no significant differences in ABL and L/P before and after fluid loading.Conclusions:These results imply that in patients with SIRS,the reasons of an increase in ABL may include metabolic dysfunction in addition to hypovolemia and tissue hypoxia.The metabolic dysfunction probably occurs prior to the abnormality of systemic oxygen delivery.
出处
《中国危重病急救医学》
CAS
CSCD
1998年第10期632-635,共4页
Chinese Critical Care Medicine
关键词
全身
炎性反应综合征
乳酸
氧消耗
氧输送
systemic inflammatory response syndrome\ \ lactate\ \ pyruvate\ \ oxygen consumption\ \ oxygen delivery
