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首页> 外文期刊>Critical care : >Lactate concentration gradient from right atrium to pulmonary artery.
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Lactate concentration gradient from right atrium to pulmonary artery.

机译：从右心房到肺动脉的乳酸浓度梯度。

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INTRODUCTION: We compared simultaneous measurements of blood lactate concentration ([Lac]) in the right atrium (RA) and in the pulmonary artery (PA). Our aim was to determine if the mixing of right atrial with coronary venous blood, having substantially lower [Lac], results in detectable decreases in [Lac] from the RA to the PA. METHODS: A prospective, sequential, observational study was conducted in a medical-surgical intensive care unit. We enrolled 45 critically ill adult individuals of either sex requiring pulmonary artery catheters (PACs) to guide fluid therapy. Immediately following the insertion of the PAC, one paired set of blood samples per patient was drawn in random order from the PAC's proximal and distal ports for measurement of hemoglobin concentration, O2 saturation (SO2) and [Lac]. We defined Delta[Lac] as ([Lac]ra - [Lac]pa), DeltaSO2 as (SraO2 - SpaO2) and the change in O2 consumption (DeltaVO2) as the difference in systemic VO2 calculated using Fick's equation with either SraO2 or SpaO2 in place of mixed venous SO2. Data were compared by paired Student's t-test, Spearman's correlation analysis and by the method of Bland and Altman. RESULTS: We found SraO2 > SpaO2 (74.2 +/- 9.1 versus 69.0 +/- 10.4%; p < 0.001) and [Lac]ra > [Lac]pa (3.9 +/- 3.0 versus 3.7 +/- 3.0 mmol x l-1; p < 0.001). Delta[Lac] correlated with DeltaVO2 (r2 = 0.34; p < 0.001). CONCLUSION: We found decreases in [Lac] from the RA to PA in this sample of critically ill individuals. We conclude that parallel decreases in SO2 and [Lac] from the RA to PA support the hypothesis that these gradients are produced by mixing RA with coronary venous blood of lower SO2 and [Lac]. The present study is a preliminary observation of this phenomenon and further work is needed to define the physiological and clinical significance of Delta[Lac].
机译：简介：我们比较了右心房（RA）和肺动脉（PA）中血乳酸浓度（[Lac]）的同时测量。我们的目的是确定右心房与[Lac]明显较低的冠状静脉血混合是否会导致从RA到PA的[Lac]下降。方法：在医学外科重症监护室进行了一项前瞻性，序贯，观察性研究。我们招募了45位需要肺动脉导管（PAC）指导体液治疗的任何性别的重症成年个体。插入PAC后，立即从PAC的近端和远端端口随机抽取每对患者的一对血液样本，以测量血红蛋白浓度，O2饱和度（SO2）和[Lac]。我们将Delta [Lac]定义为（[Lac] ra-[Lac] pa），将DeltaSO2定义为（SraO2-SpaO2），将O2消耗量的变化（DeltaVO2）定义为使用Fick方程对SraO2或SpaO2计算得出的系统性VO2的差异。代替混合静脉SO2。通过配对的学生t检验，Spearman相关分析以及Bland和Altman方法对数据进行比较。结果：我们发现SraO2> SpaO2（74.2 +/- 9.1对69.0 +/- 10.4％; p <0.001）和[Lac] ra> [Lac] pa（3.9 +/- 3.0对3.7 +/- 3.0 mmol x l -1; p <0.001）。 Delta [Lac]与DeltaVO2相关（r2 = 0.34; p <0.001）。结论：我们发现该危重患者样本中[Lac]从RA到PA降低。我们得出的结论是，从RA到PA的SO2和[Lac]平行下降，支持以下假设：这些梯度是通过将RA与较低SO2和[Lac]的冠状静脉血混合而产生的。本研究是对该现象的初步观察，需要进一步的工作来确定Delta [Lac]的生理和临床意义。

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