乳酸评价急性胸痛的临床研究  

Effect of lactate to evaluate patients with acute chest pain

作　　者：何新华[1] 李春盛[2] 甘立平[1] 朱雄龙[1] 李爱民[1] 杨红梅[1] 

机构地区：[1]北京军区总医院急诊科,北京100700 [2]北京朝阳医院急诊科

出　　处：《中国急救医学》2001年第4期205-207,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的　检验乳酸诊断急性心肌梗死 (AMI)及判断危重心脏病患者预后的假说。方法　急性胸痛或其它典型AMI症状的患者检测静脉血乳酸。高于 2 0mmol/L作为急性心脏疾病的预测值。同时检测心肌磷酸激酶 (CK)和同工酶 (CK-MB) ,记录ECG。结果　全部 114例患者 ,6 5例乳酸高于 2 0mmol/L。 2 5例 (2 2 % )确诊为急性心肌梗死 (AMI) ,其乳酸为 2 7± 0 7mmol/L。而Non～AMI乳酸为 2 2± 0 8mmol/L(P <0 0 5 )。乳酸诊断AMI的敏感性为 96 % (95 %CI为 89%～ 10 0 % ) ,特异性为 5 5 % (95 %CI为 45 %～ 6 4% ) ,乳酸阴性预计值为 96 % (95 %CI为 89%～ 10 0 % )。胸痛患者乳酸升高的平均时间为发病 3h以内。死亡或要求ICU治疗 48h以上的患者其乳酸也明显升高 ,与不要求ICU治疗者比较其乳酸分别是 5 0± 4 3mmol/L比 1 9± 0 6mmol/L(P <0 0 1)。结论　乳酸对AMI具有较高的阴性预计值 。Objective To test the hypothesis that ED arrival venous lactate levels can be used to diagnose acute myocardial infarction(AMI)and to identify patients with critical cardiac illness in the triage of ED patients presenting with chest pain.Methods We enrolled a convenience sample of adult patients who had chest pain or cardial symptoms suggesting AMI that began within 24 hours of presentation.Venous lactate sample were analyzed in the ED on whole blood.An abnormal lactate level of 2.0 mmol/L or higher at the time of arrival prospectively defined as indicating the presence of acute cardiac disease.ECG findings,levels of creatine phosphokinase (CK) and CK-MB were recorded.Results Of the 114 patients included in the study,65 had an initial lactate level of 2.0 mmol/L or higher.A total of 25 patients(22%)were diagnosed with AMI and had a mean lactate of 2.7±0.7 mmol/L,compared with 2.2±0.8 mmol/L in those patients who were not diagnosed with AMI( P <0.05).The sensitivity of this lactate level in diagnosing AMI was 96%(95% confidence interval(CI),89% to 100%),and the specificity was 55%(95% CI,45% to 64%).The negative predictive value of blood lactate was 96%(95% CI,89% to 100%).Lactate was elevated independent of the duration of chest pain symptoms,with a media time from onset to sampling of 3 hours.Lactate was elevated in patients who either died or required longer than 48 hours of ICU care,compared with survivors not requiring ICU care(5.0±4.3 mmol/L vs 1.9±0.6 mmol/L,respectively; P <0.01).Conclusions A normal blood lactate result has a high negative predictive for AMI.Hyperlactatemia clearly correlates with mortality and the need for ICU management in the acute cardiac patient presenting to the ED. [

关 键 词：乳酸 急性胸痛 CK CK-MB 急性心肌梗死 AMI 

分 类 号：R459.7[医药卫生—急诊医学]