중환자 예후 지표로서의 동맥혈 중 락트산 농도의 평가 및 APACHE II 점수와의 비교

Abstract

Background : Disordered lactate metabolism which is due to tissue hypoxia and hypoperfusion is fre-quently encountered in critically ill patients. These patients suffer from a high hospital mortality rate and are at great risk of developing multiple organ failure. The present study was designed to evaluate the prognostic value of blood lactate as a determinant of mortality in comparison with the APACHE Ⅱ score. Methods : 29 adult ICU patients participated in this study. Blood lactate concentrations, arterial blood gas analysis, hemodynamic data and APACHE Ⅱ scores were collected on the first and last days of ICU stay. These data were compared between survivor and non-survivor groups. Result : On the day of admission blood lactate concentrations and APACHE Ⅱ scores of non-survivors were 48.5±27,0 mg/dl and 18.5±5.9, while those of survivors were 23.7 ±12.9 mg/dl and 6.7±3.1. On the day of discharge, arterial blood lactate concentrations and APACHE Ⅱ scores of non-survivors were 143.2±54.0 mg/dl and 28.2± 6.0, while those of survivors were 14.9±7.1 mg/dl and 4.7±2.2. There was a significant positive correlation between high arterial blood lactate concentration and fatal outcome in critically-ill patients. There was also a significant positive correlation between arterial blood lactate concenlration and APACHE Ⅱ score. Furthermme, decreases in arterial blood lactate levels during the course of ICU stay may indicate a favorable outcome. The mortality increased abruptly in critically-ill patients with an initial arterial blood lactate concentration higher than 40 mg/dl. Conclusions : The result shows that arterial blood lactate concentration can starve as a reliable prognostic predictor and clinical guide to therapy in critically ill patients. (Korean J Anesthesiol 2000; 38: 99-104)