Central venous oxygen saturation and blood lactate levels during cardiopulmonary bypass are associated with outcome after pediatric cardiac surgery.
Central venous oxygen saturation and blood lactate levels during cardiopulmonary bypass are associated with outcome after pediatric cardiac surgery.
复制标题
DOI：
10.1186/cc9217
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Surgical and Clinical Outcome REsearch Group
中科院分区：
文献类型：
--
作者：
Ranucci M;Isgrò G;Carlucci C;De La Torre T;Enginoli S;Frigiola A;Surgical and Clinical Outcome REsearch Group
中心静脉血氧饱和度和血乳酸是氧输送是否足以满足氧需求的不同指标。在小儿心脏手术中，体外循环期间和之后的乳酸水平和动力学与结果变量相关。本研究的目的是探讨心肺转流期间最低中心静脉血氧饱和度和峰值乳酸值（单独或联合使用）可能预测小儿心脏手术中主要发病率和死亡率的假设。我们对256名接受心脏手术的儿科（6岁以下）患者进行了回顾性分析，连续监测中心静脉血氧饱和度并连续测量血乳酸。当中心静脉血氧饱和度最低值<68%时，乳酸峰值显著增加。体外循环期间中心静脉血氧饱和度最低值和乳酸峰值与主要发病率和死亡率独立相关，主要发病率的准确性相同，乳酸峰值对死亡率的准确性更高。联合指数（中心静脉血氧饱和度< 68% and peak lactate >3 mmol/L）为主要发病率提供了最高的敏感性和特异性，阳性预测值为89%。在心肺转流术期间连续监测中心静脉血氧饱和度和连续测量血乳酸的组合可以为儿科患者心脏手术后的主要发病率提供预测指标。本研究产生了一个假设，即在心肺转流过程中，旨在保护氧气输送的策略可能会减少中心静脉血氧饱和度低值和乳酸水平升高的发生。进一步的研究应考虑这一假设，并考虑其他时间相关因素，如暴露于中心静脉血氧饱和度低值的时间和乳酸形成的动力学。
Central venous oxygen saturation and blood lactate are different indices of the adequacy of oxygen delivery to the oxygen needs. In pediatric cardiac surgery, lactate level and kinetics during and after cardiopulmonary bypass are associated with outcome variables. The aim of this study was to explore the hypothesis that the lowest central venous oxygen saturation and the peak lactate value during cardiopulmonary bypass, used alone or in combination, may be predictive of major morbidity and mortality in pediatric cardiac surgery. We conducted a retrospective analysis of 256 pediatric (younger than 6 years) patients who had undergone cardiac surgery with continuous monitoring of central venous oxygen saturation and serial measurement of blood lactate. Peak lactate was significantly increased when the nadir central venous oxygen saturation was < 68%. Both nadir central venous oxygen saturation and peak lactate during cardiopulmonary bypass were independently associated with major morbidity and mortality, with the same accuracy for major morbidity and a higher accuracy of peak lactate for mortality. A combined index (central venous oxygen saturation < 68% and peak lactate > 3 mmol/L) provided the highest sensitivity and specificity for major morbidity, with a positive predictive value of 89%. The combination of a continuous monitoring of central venous oxygen saturation and serial measurements of blood lactate during cardiopulmonary bypass may offer a predictive index for major morbidity after cardiac operations in pediatric patients. This study generates the hypothesis that strategies aimed to preserve oxygen delivery during cardiopulmonary bypass may reduce the occurrence of low values of central venous oxygen saturation and elevated lactate levels. Further studies should consider this hypothesis and take into account other time-related factors, such as time of exposure to low values of central venous oxygen saturation and kinetics of lactate formation.
登录
查看更多内容
影响因子：
--
作者：
Wilson, J;Woods, I;McManus, E
通讯作者：
McManus, E
影响因子：
5.7
作者：
Murkin, John M.;Adams, Sandra J.;Fox, Stephanie
通讯作者：
Fox, Stephanie
影响因子：
158.5
作者：
Rivers, E;Nguyen, B;Tomlanovich, M
通讯作者：
Tomlanovich, M
影响因子：
1.7
作者：
Weiss, M;Dullenkopf, A;Baenziger, O
通讯作者：
Baenziger, O
影响因子：
1.7
作者：
Ranucci, Marco;Isgro, Giuseppe;Carlucci, Concetta
通讯作者：
Carlucci, Concetta