응급실로 내원한 산후 출혈 환자의 중증도 예측 인자로서 젖산 농도의 유용성
The usefulness of lactate as an early predictor of the severity of emergency department patients with postpartum hemorrhage
조영준, 유제성, 정성필, 좌민홍, 공태영, 고동률, 황윤정, 이용희, 박인철, 김시내,
소속 상세정보
조영준 ( Cho Young-Joon )
연세대학교 의과대학 응급의학교실
유제성 ( You Je-Sung )
연세대학교 의과대학 응급의학교실
정성필 ( Chung Sung-Phil )
연세대학교 의과대학 응급의학교실
좌민홍 ( Choa Min-Hong )
연세대학교 의과대학 응급의학교실
공태영 ( Kong Tae-Young )
연세대학교 의과대학 응급의학교실
고동률 ( Ko Dong-Ryul )
연세대학교 의과대학 응급의학교실
황윤정 ( Hwang Yoon-Jung )
연세대학교 의과대학 응급의학교실
이용희 ( Lee Yong-Hee )
연세대학교 의과대학 응급의학교실
박인철 ( Park In-Cheol )
연세대학교 의과대학 응급의학교실
김시내 ( Kim Si-Nae )
연세대학교 의과대학 연구부 통계지원팀
KMID : 0385920190300010033
Abstract
Objective: Only a few studies have examined the role of lactate reflecting on tissue hypoperfusion determining the severity of postpartum hemorrhage (PPH) patients in the emergency department (ED). This study evaluated the utility of the arterial lactate level as a prognostic marker of severity in PPH patients admitted to an ED.
Method: This retrospective, observational cohort study was conducted on patients integrated prospectively in a critical pathway of SPEED (Severance Protocol to save postpartum bleeding through Expeditious care Delivery). Adult primary PPH patients admitted to the ED between July 1, 2010 and March 31, 2017 were analyzed. The outcomes were the development of severe PPH including death, hysterectomy, surgical treatment, and massive transfusion.
Results: A total of 112 patients were enrolled in this study. An increase in the arterial lactate value was a strong independent predictor of severe PPH. The increasing predictability of severe PPH was closely associated with an arterial lactate ≥3.15 mL/L at admission (odds ratio, 13.870; P<0.001).
Conclusion: Lactate is an independent predictor of severe PPH and is suitable for a rapid and simple estimation of the severity of PPH. Emergency physicians can use lactate to determine the initial treatment strategies more precisely.
키워드
Postpartum hemorrhage; Prognosis; Lactic acid
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