Title: Lactate use in the pediatric emergency department
题目：乳酸水平在儿科急诊中的应用
Author 作者: Jennifer Guyther

Lactate is commonly used in the adult ED when evaluating septic patients, but there is a lack of literature validating its use in the pediatric ED. Pediatric studies have suggested that in the ICU population, elevated lactate is a predictor of mortality and may be the earliest marker of death.

乳酸通常用于在急诊科对成人脓毒症患者进行评估，但对其在儿科急诊的应用却缺乏文献资料。儿科的研究表明，在ICU病人中，乳酸升高是一个预测死亡的一个指标，可能是一个最早的预测死亡的标记。
A retrospective chart review over a 1 year period showed that one elevated serum lactate correlated with increased pulse, respiratory rate, white blood cell count and platelets. Serum lactate had a negative correlation with BUN, serum bicarbonate and age.
超过1年的回顾性调查表研究显示， 高血清乳酸与增加的脉搏，呼吸率，白细胞计数和血小板有关。但血清乳酸与BUN，血清碳酸氢钠和年龄呈负相关。
Elevated lactate levels were higher for admitted patients. However, the mean serum lactate level was not statistically different between those diagnosed with sepsis and those that were not.

The study included 289 patients less then 18 years who had both blood cultures and lactate drawn.
住院病人的乳酸水平较高高 。然而，确诊为败血症病人的平均血清乳酸水平与没有败血症病人没有统计学差异。该研究收入了289例小于18岁并都做了血培养和乳酸测定的病人 。
This community hospital had a sepsis protocol in place that automatically ordered a lactate with blood cultures. Only previously healthy children were included. The study is limited by its small sample size and overall low lactate levels.
这个私立医院有一个常规的败血症治疗方案，会自动检测乳酸和做血培养。只有以往健康的儿童包括在研究内。这项研究的缺陷为小样本和乳酸水平低。
Despite having a protocol in place, only 39% of patients who had blood cultures drawn and had lactate levels available for analysis. The mean serum lactate in this study was 2.04 mM indicating that the study population may not have been sick enough to determine mortality implications. There were no serial measurements.
尽管有一个成形的方案，只有39％的患者有血培养和乳酸水平的结果可用于分析。这项研究的的平均血清乳酸为2.04毫摩尔，表明这些病人的病情并没有严重到可以用来判断死亡率 。同时，又没有对乳酸进行连续测量。

Bottom line: Consider measuring serum lactate in your pediatric patient with suspected sepsis. Pediatric ICU literature does suggest that a serum lactate as low as 3mM is associated with an increased mortality in the ICU.
要点：对你的疑似败血症儿科病人，要考虑测定血清乳酸水平。儿科ICU文献确实表明即使3毫摩尔的血清乳酸也与增加的ICU死亡率相关。

References 参考文献：
Reed et al. Serum Lactate as a Screening Tool and Predictor of Outcome in Pediatric Patients Presenting to the Emergency Department With Suspected Infection. Pediatric Emergency Care. 2013; Vol 29: 787-791.