Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease
Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease
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DOI：
10.1067/mtc.2000.106838
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发表时间：
2000-07-01
影响因子：
6
通讯作者：
Kulik, TJ
中科院分区：
文献类型：
--
作者：
Charpie, JR;Dekeon, MK;Kulik, TJ
目的：先天性心脏病新生儿术后可能血流动力学看似稳定，但随后会突然发生灾难性的失代偿。一种改进的预测哪些婴儿会在术后早期突然死亡的方法可能会带来挽救生命的干预措施。研究表明，血乳酸水平与组织氧债成正比，但关于术后婴儿乳酸水平与预后相关的信息有限。我们试图确定乳酸水平随时间的变化是否可预测不良预后，不良预后定义为术后72小时内死亡或需要体外膜肺氧合。
方法：为了验证这一假设，我们前瞻性地研究了46例年龄小于1个月且正在接受复杂心脏手术姑息治疗或修复的婴儿。在进入重症监护病房时以及术后前3天每3 - 12小时记录动脉血氧饱和度、碳酸氢盐和乳酸水平。
结果：37例患者预后良好，9例患者预后不良。预后不良患者的初始平均乳酸水平（9.4 ± 3.8 mmol/L）显著高于预后良好患者（5.6 ± 2.1 mmol/L；P = 0.03）。然而，初始乳酸水平升高超过6 mmol/L对不良预后的阳性预测值较低（38%）。相比之下，乳酸水平每小时变化0.75 mmol/L或更多与不良预后相关（P <...（此处原文似乎不完整）
Objectives: Neonates with congenital heart disease may appear hemodynamically stable after operation and then suddenly experience catastrophic decompensation. An improved means of predicting which infants will suddenly die in the early postoperative period may lead to lifesaving interventions. Studies indicate that blood lactate level is proportional to tissue oxygen debt, but information linking lactate levels with outcome in infants after operation is limited. We sought to determine whether a change in lactate level over time was predictive of a poor outcome defined as death within the first 72 hours or the need for extracorporeal membrane oxygenation.Methods: To test this hypothesis, we studied prospectively 46 infants who were less than 1 month old and were undergoing complex cardiac surgical palliation or repair. Postoperative arterial oxygen saturation, bicarbonate, and lactate levels were recorded on admission to the intensive care unit and every 3 to 12 hours for the first 3 days.Results: Thirty-seven patients had a good outcome, and 9 patients had a poor outcome. Mean initial lactate level was significantly greater in patients with a poor outcome (9.4 +/- 3.8 mmol/L) than in patients with a good outcome (5.6 +/- 2.1 mmol/L; P =.03). However, an elevated initial lactate level of more than 6 mmol/L had a low positive predictive value (38%) for poor outcome. In contrast, a change in lactate level of 0.75 mmol/L per hour or more was associated with a poor outcome (P