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首页> 外文期刊>Critical care : >Better lactate clearance associated with good neurologic outcome in survivors who treated with therapeutic hypothermia after out-of-hospital cardiac arrest
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Better lactate clearance associated with good neurologic outcome in survivors who treated with therapeutic hypothermia after out-of-hospital cardiac arrest

机译：院外心脏骤停后接受低温治疗的幸存者中乳酸清除率更高，神经系统预后良好

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IntroductionSeveral methods have been proposed to evaluate neurological outcome in out-of-hospital cardiac arrest (OHCA) patients. Blood lactate has been recognized as a reliable prognostic marker for trauma, sepsis, or cardiac arrest. The objective of this study was to examine the association between initial lactate level or lactate clearance and neurologic outcome in OHCA survivors who were treated with therapeutic hypothermia.MethodsThis retrospective cohort study included patients who underwent protocol-based 24-hour therapeutic hypothermia after OHCA between January 2010 and March 2012. Serum lactate levels were measured at the start of therapy (0?hours), and after 6?hours, 12?hours, 24?hours, 48?hours and 72?hours. The 6?hour and 12?hour lactate clearance were calculated afterwards. Patients’ neurologic outcome was assessed at one month after cardiac arrest; good neurological outcome was defined as Cerebral Performance Category one or two. The primary outcome was an association between initial lactate level and good neurologic outcome. The secondary outcome was an association between lactate clearance and good neurologic outcome in patients with initial lactate level >2.5?mmol/l.ResultsOut of the 76 patients enrolled, 34 (44.7%) had a good neurologic outcome. The initial lactate level showed no significant difference between good and poor neurologic outcome groups (6.07 ±4 .09?mmol/L vs 7.13?±?3.99?mmol/L, P?=?0.42), However, lactate levels at 6?hours, 12?hours, 24?hours, and 48?hours in the good neurologic outcome group were lower than in the poor neurologic outcome group (3.81?±?2.81 vs 6.00?±?3.22 P <0.01, 2.95?±?2.07 vs 5.00?±?3.49 P <0.01, 2.17?±?1.24 vs 3.86?±?3.92 P <0.01, 1.57?±?1.02 vs 2.21?±?1.35 P?=?0.03, respectively). The secondary analysis showed that the 6-hour and 12-hour lactate clearance was higher for good neurologic outcome patients (35.3?±?34.6% vs 6.89?±?47.4% P?=?0.01, 54.5?±?23.7% vs 25.6?±?43.7% P <0.01, respectively). After adjusting for potential confounding variables, the 12-hour lactate clearance still showed a statistically significant difference (P?=?0.02).ConclusionThe lactate clearance rate, and not the initial lactate level, was associated with neurological outcome in OHCA patients after therapeutic hypothermia.
机译：简介已经提出了几种方法来评估院外心脏骤停（OHCA）患者的神经系统结果。血乳酸已被公认为是创伤，败血症或心脏骤停的可靠预后标志物。这项研究的目的是检查接受低温治疗的OHCA幸存者中初始乳酸水平或乳酸清除率与神经系统结局之间的关系。方法这项回顾性队列研究包括一月至OHCA术后接受基于方案的24小时低温治疗的患者。 2010年和2012年3月。在治疗开始时（0小时），6小时，12小时，24小时，48小时和72小时后测量血清乳酸水平。之后计算6小时和12小时的乳酸清除率。在心脏骤停后一个月评估患者的神经系统结果;良好的神经系统预后被定义为脑功能类别一或二。主要结局是初始乳酸水平与良好的神经系统结局之间的关联。次要结果是初始乳酸水平> 2.5？mmol / l的患者中乳酸清除率与良好的神经系统预后之间的关联。结果在纳入的76例患者中，有34例（44.7％）的神经系统预后良好。初始乳酸水平显示好和差的神经系统结局组之间无显着差异（6.07±4 .09？mmol / L与7.13？±？3.99？mmol / L，P？=？0.42），但是，乳酸水平在6？4。良好的神经系统预后组的小时，12小时，24小时和48小时低于不良神经系统预后组（3.81±±2.81 vs 6.00±±3.22 P <0.01，2.95±±2.07相对于5.00±±3.49 P ＜0.01、2.17±±1.24与3.86±±3.92 P ＜0.01、1.57±±1.02与2.21±±1.35 P ＜＝ 0.03。二级分析显示，神经系统预后良好的患者的6小时和12小时乳酸清除率更高（35.3±±34.6％比6.89±±47.4％P？= 0.01、54.5±±23.7％和25.6。分别为±±43.7％，P ＜0.01。在校正了潜在的混杂变量后，12小时的乳酸清除率仍显示出统计学上的显着差异（P？=？0.02）。结论低温治疗后OHCA患者的乳酸清除率与初始乳酸水平无关，与神经系统结局有关。

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