动脉血乳酸与急性ST段抬高型心肌梗死临床相关性分析  

Clinical correlates of arterial lactate levels in patients with ST-segment elevation myocardial infarction

作　　者：薛明 周文博 XUE Ming;ZHOU Wen-bo(Xuzhou Hospital of Traditional Chinese Medicine of Jiangsu Province,ICU,Jiangsu Xuzhou 221003,China)

机构地区：[1]江苏省徐州市中医院ICU,江苏徐州221003

出　　处：《中西医结合心血管病电子杂志》2018年第7期45-47,共3页Cardiovascular Disease Electronic Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察动脉血乳酸(Lac)水平的变化与ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)临床相关性分析。方法回顾性收集我院2014年3月至2018年2月CCU及ICU STEMI149例,予以急诊PCI后入CCU及ICU,收集6小时内Lac,根据血Lac水平分为两组:小于2.0 mmol/L,≥2.0 mmol/L;对两组年龄、性别、心率(HR)、BMI、休克、危险因素(高血压病、糖尿病、高胆固醇血症、吸烟)、血红蛋白(HB)、肌酐(Cr)、肌钙蛋白T峰值(PcTnT)、30天死亡率等数据进行分析。对LAC水平细分7个组(<1.2 mmol/L、1.2~1.5 mmol/L、1.6~1.9 mmol/L、2.0~2.9 mmol/L、3.0~3.9 mmol/L、4.0~4.9 mmol/L、≥5.0 mmol/L)观察随着Lac水平的升高其30日死亡率的变化。结果两组不同乳酸水平的数据分析结果示,性别、年龄、HB、BMI及高胆固醇血症等比较无统计学差异(P>0.05)。休克发生率增加(P<0.05)、HR增快(P=0.007)、肌酐增高(P=0.003)、高血压病(P=0.024)、糖尿病及有吸烟史者(P<0.05)比率增高;30天死亡率也是明显上升的(3.8%vs20.5%P<0.05)。对LAC水平细分7个组同样可以明显的观察到随着Lac的增加,30天死亡率明显上升,当Lac≥5.0 mmol/L死亡率达到60%。结论 STEMI患者血流动力学障碍、HR增快、肌酐增高、高血压病及糖尿病等与Lac水平增高有相关性;Lac水平(特别是≥2.0 mmol/L)的增高为STEMI行急诊PCI术患者对30日死亡率有独立的预测价值。Objective We sought to evaluate the clinical correlates of arterial lactate levels in patients with ST-segment elevation myocardial infarction.Methods We studied clinical records of 149 patients treated with primary percutaneous coronary intervention(PCI),divided into two groups with lactate levels<2.0(n=105)and≥2.0 mmol/l(n=44),treated in CCU and ICU,from March 2014 to February 2018,with diagnosis ST-elevation AMI.We measured arterial lactate levels with a rapid point-of-care technique.We compared both baseline characteristics and outcome measures of the two lactate groups.Results Factors independently associated with higher lactate levels were hypotension,heart rate,PcTnI,creatinine,hypertension,diabetes and smoking.Mortality at 30 days in the two groups was 3.8%and 20.5%.Conclusion In STEMI patients,impaired hemodynamics,,heart rate,PcTnI,creatinine,hypertension,diabetes and smoking were related to increased arterial lactate levels.Higher lactate levels were independently related with 30-day mortality.In particular,acute mortality was related to admission lactates≥2.0 mmol/L.

关 键 词：ST段抬高型急性心肌梗死 血乳酸 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]