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每个重症治疗师都应该知道什么关于在败血症休克中乳酸的双相动力学

Ricardo Castro¹, Glenn Hernández¹, Eduardo Kattan¹

¹Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago Centro, Chile; Hospital Clínico UC-CHRISTUS, Pontificia Universidad Católica de Chile, Santiago, Chile..

Journal of critical care

|October 16, 2025

概括

浸性休克中的乳酸水平有两个阶段. 早期的升高表明血液流动不良,而后来的升高表明代谢变化,需要与 perfusion 标志物一起进行仔细的解释,以获得有效的治疗.

科学领域:

关键护理医学关键护理医学
生物化学生化学
身体生理学身体生理学

背景情况:

乳酸是败血症休克的一个关键生物标志物,但由于双相动力学,它的解释是复杂的.
乳酸水平升高可能反映组织低 perfusion 或代谢重编程,需要细致的理解.

研究的目的:

为了阐明乳酸的双相动力学在败血性休克幸存者.
为了区分流量依赖和代谢驱动的超乳糖血症.
为了指导解释乳酸水平与输液指数结合,以实现最佳的患者管理.

主要方法:

分析临床和实验数据的乳酸动力学在败血症休克.
综述了与不同 perfusion 环境下的结果相关的持续性高乳糖血症研究.
评估试验数据,如安德罗米达-SHOCK,比较乳酸引导与输液引导的复苏.

主要成果:

乳酸清除表现出初始的流量依赖阶段 (6-12h) 和后来的代谢阶段 (>12h).
持久性高乳酸血症与低 perfusion 迹象相关,与更糟糕的结果.
没有低输血的高乳糖血症可能会误导,并有过度复苏的风险.

结论:

乳酸盐应该被视为在败血性休克时的血液动力学和代谢生物标志物.
将乳酸解释与输液指数 (例如毛细血管补充时间) 结合起来,对于指导复苏至关重要.
这种综合方法有助于及时升级,降低升级和选择辅助疗法.

关键词:

乳酸盐是一种乳酸盐.线粒体中的线粒体.败血症这是一种败血症.败血症的冲击是一个令人震惊的结果.

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