围手术期急性心肌梗死患者乳酸和乳酸清除率水平研究

目的:通过冠心病患者术后早期动脉血乳酸水平及乳酸清除率,评价其对围术期急性心肌梗死(perioperative acute myocardial infarction,PAMI)的发病、预后的提示作用。方法:入选2010年1月至2012年3月,入住我院SICU的冠心病患者,比较其中确诊为围术期PAMI的35例患者,及围术期平稳过渡的31例患者,动脉乳酸值及血乳酸清除率进行回顾性分析。结果:研究显示,PAMI患者初始乳酸水平(3.05±1.18)mmol/L较非心肌梗死患者(1.70±0.79)mmol/L明显增高,而6 h乳酸水平分别为心肌梗死组(2.10±0.89)mmol/L非心肌梗死组(0.96±0.41)mmol/L,差异具有统计学意义(P<0.05),心肌梗死患者中初始乳酸水平在KillipⅠ、Ⅱ级(2.24±0.88)mmol/L及KillipⅢ、Ⅳ级(3.89±1.45)mmol/L之间,差异有统计学意义(P<0.05),而患者术后心肌梗死乳酸清除率则无明显减少,显示乳酸清除率不能明确提示PAMI发生概率上升。结论:乳酸测量可作为ICU医师对PAMI的另一有效的预警指标。

The research of level of lactate and lactate clearance in patients with perioperative acute myocardial infarction

Objective:To study the perioperative level of lactate(LA)and lactate clearance(LC)in patients with coronary artery disease(CAD)and evaluate its warning effect in perioperative acute myocardial infarction(PAMI).Methods:Contrast the level of lactate and lactate clearance in 66 patients,including 35 patients with PAMI and 31 CAD patients who smooth transit the perioperative stage.Results:Higher levels of initiate LA were found in PAMI patients(3.05±1.18)mmol/L compare with no PAMI group(1.70±0.79)mmol/L(P<0.05).The statistics difference was found in PAMI patients(2.10±0.89)mmol/L compare with no PAMI group(0.96±0.41)mmol/Lin level of 6 h LA.Comparing initiate LA of patients with PAMI,the statistics difference was found between Killip Ⅰ、Ⅱ degree group(2.24±0.88)mol/Land Killip Ⅲ、Ⅳ degree group(3.89±1.45)mmol/L.Conclusion: The result show that LA level is a good warning indicator for PAMI.