血乳酸浓度监测与组织氧合相关性的临床观察

目的　寻找能反映严重烧伤后组织氧合状况的简便易行、微创、有效的生化指标。方法　将收治的 34例大面积烧伤患者随机分为两组 ,A组 18例 ,采用改进后的抗休克复苏方案 ,使患者尿量维持在每小时 10 0ml左右 ;B组 16例 ,采用常规补液公式 ,使患者尿量维持在每小时 4 0ml左右。两组同时于复苏前、复苏后 1、8、16、2 4、4 8、72h监测血乳酸浓度 (BL)及常规监测指标 (尿量、血压、心率、神志 )。　结果　 (1)A组患者复苏后 2 4h内 ,血BL浓度平均为 (3.2± 0 .4 )mmol/L ,常规指标均处于正常范围 ;B组患者常规指标基本正常 ,血BL平均值为 (7.4± 1.6 )mmol/L ,持续时间可达 72h以上。 (2 )在常规监测指标指导下 ,B组复苏治疗效果不佳 ,病死率高 (31.2 % ) ;A组通过监测BL指导治疗 ,病死率仅为 5 .5 %。 (3)BL与尿量呈负相关 ,与心率呈正相关。　结论　 (1)严重烧伤休克时组织的乏氧代谢增强 ,监测血BL ,能基本达到快捷、灵敏、简单、有效、微创的要求 ,是反映全身组织器官氧合状况的良好指标。 (2 )建议烧伤抗休克的复苏时间应延长至 72h ,尿量保持在 10 0ml/h ,确保复苏的质量和效果。

Clinical investigation of the correlation between blood concentration of lactic acid and tissue oxygenation in severely burned patients

OBJECTIVE: To investigate the relationship between blood concentration of lactic acid (LA) and tissue oxygenation in severely burned patients with shock. METHODS: Thirty-four severely burned patients admitted during early postburn stage were included in this study and were randomly divided into A (n = 18) and B (n = 16) groups. The patients in A group were resuscitated with modified anti-shock programme by which the patients' urine output was maintained roughly around 100ml per hour, while the patients in B group were treated by our traditional resuscitation formula by which the patients urine was kept at 40 ml per hour. The blood concentration of LA and usual indices (urine output, blood pressure, heart rate, and mental status) were simultaneously monitored before and 1, 8, 16, 24, 48 and 72 hours after resuscitation in patients of both groups. RESULTS: (1) The average blood LA level in patients of A group was (3.2 +/- 0.4) mmol/L within 24 hours of resuscitation, while the monitored indices remained within normal range. Nevertheless the LA level in B group was (7.4 +/- 1.6) mmol/L (P < 0.01, compared with that of A group), and hyperlactacidemia lasted for more than 72 hours while other indices were normal. (2) The mortality in B group was high (31.2%), whilst that in A-group was only 5.5% (P < 0.01). (3) There was negative correlation between blood LA and urine output and positive correlation between blood LA and heart rate. CONCLUSION: (1) Blood LA concentration might be taken as an immediate, sensitive, simple and useful index of tissue oxygenation of the whole body during burn shock stage. (2) It was suggested by our results that fluid resuscitation should be extended to 72 PBHs (postburn hours) with urine output over 100 ml/h, so as to ensure the quality and effects of the resuscitation of burn shock.