CAJ | 학술논문

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，65例乳酸高于2.0mmol/L。25例(22%)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＜0.05)。乳酸诊断AMI的敏感性为96%(95%CI为89%～100%)，特异性为55%(95%CI为45%～64%)，乳酸阴性预计值为96%(95%CI为89%～100%)。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＜0.01)。结论乳酸对AMI具有较高的阴性预计值，高乳酸血症与急性心脏病患者病死率及要求住院有明显的相关性。
목적 검험유산진단급성심기경사(AMI)급판단위중심장병환자예후적가설。방법 급성흉통혹기타전형AMI증상적환자검측정맥혈유산。고우2.0mmol/L작위급성심장질병적예측치。동시검측심기린산격매(CK)화동공매(CK-MB)，기록ECG。결과 전부114례환자，65례유산고우2.0mmol/L。25례(22%)학진위급성심기경사(AMI)，기유산위2.7±0.7mmol/L。이Non～AMI유산위2.2±0.8mmol/L(P＜0.05)。유산진단AMI적민감성위96%(95%CI위89%～100%)，특이성위55%(95%CI위45%～64%)，유산음성예계치위96%(95%CI위89%～100%)。흉통환자유산승고적평균시간위발병3h이내。사망혹요구ICU치료48h이상적환자기유산야명현승고，여불요구ICU치료자비교기유산분별시5.0±4.3mmol/L비1.9±0.6mmol/L(P＜0.01)。결론 유산대AMI구유교고적음성예계치，고유산혈증여급성심장병환자병사솔급요구주원유명현적상관성。
Objective To test the hypothesis that ED arrival venous lactatelevels 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.