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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 ,6 5例乳酸高于 2 0mmol/L。 2 5例 (2 2 % )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 0 5 )。乳酸诊断AMI的敏感性为 96 % (95 %CI为 89%～ 10 0 % ) ,特异性为 5 5 % (95 %CI为 45 %～ 6 4% ) ,乳酸阴性预计值为 96 % (95 %CI为 89%～ 10 0 % )。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 0 1)。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
Objective To test the hypothesis that lactic acid is used to diagnose acute myocardial infarction (AMI) and to predict the prognosis of critically ill patients with heart disease. Methods Venous blood lactate was tested in patients with acute chest pain or other typical AMI symptoms. Higher than 20mmol / L as a predictive value of acute heart disease. Cardiac phosphokinase (CK) and isoenzyme (CK-MB) were also detected and ECG was recorded. Results All 114 patients, 65 cases of lactate higher than 20mmol / L. Twenty-five (22%) patients were diagnosed as acute myocardial infarction (AMI) with lactate of 27 ± 0 7mmol / L. Non-AMI lactic acid was 22 ± 0 8 mmol / L (P <0 05). The sensitivity of lactate to AMI was 96% (95% CI 89% to 100%), specificity was 55% (95% CI 45% to 64%) and lactate negative was 96% (95% % CI 89% ~ 100%). Patients with chest pain increased the average time lactic acidosis within 3h. Lactic acid was also significantly increased in patients who died or required treatment for more than 48 hours in the ICU compared with 50 ± 4 3 mmol / L and 1 9 ± 0 6 mmol / L, respectively (P <0.01) when compared with those who did not require ICU therapy. Conclusion Lactic acid has a high negative predictive value for AMI. There is a clear correlation between hyperlactic acidosis and mortality in patients with acute heart disease and hospitalization