乳酸酸中毒的诊断和治疗

Diagnosis and treatment of lactic acidosis

乳酸酸中毒(lactic acidosis,LA)由体内乳酸和氢离子蓄积所致,与患者预后密切相关。低灌注或脓毒症患者一旦合并LA,则死亡率增加近3倍;乳酸越高,预后越差。高乳酸血症通常源于组织缺氧,但也可由其他机制产生。控制诱因是治疗LA唯一有效手段。本文主要综述LA的发病机制、诊断、治疗和监测手段。

Lactic acidosis results from the accumulation of lactate and protons in the body fluids,and is often associated with poor clinical outcomes. Mortality is increased by a factor of nearly three times when lactic acidosis accompanies low-flow states or sepsis,and the higher the lactate level,the worse the outcome. Although hyperlactatemia is often attributed to tissue hypoxia,it can result from other mechanisms. Control of the triggering conditions is the only effective means of treatment. However,advances in understanding its pathogenesis could lead to new therapies. This paper overview the pathogenesis of lactic acidosis,as well as the diagnosis and management.