The importance of blood lactate clearance as a predictor of early mortality following the modified Norwood procedure
The importance of blood lactate clearance as a predictor of early mortality following the modified Norwood procedure
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DOI：
10.1016/j.ejcts.2011.01.081
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发表时间：
2011-11-01
影响因子：
3.4
通讯作者：
Brawn, William J.
中科院分区：
文献类型：
--
作者：
Murtuza, Bari;Wall, Douglas;Brawn, William J.
目的：优化Norwood生理学治疗左心发育不全综合征诺伍德手术后，注重全身血流灌注，对血流动力学稳定性和围手术期死亡率有有利影响。在术后阶段及早识别高危患者可能有助于制定替代治疗策略，从而有可能避免不良结局。一些研究表明，动脉血乳酸水平作为全身灌流和氧气输送的指标，在一定程度上可以预测儿科心脏手术后的死亡率，尽管这些研究包括了只有少数诺伍德患者的不同组患者。我们试图确定血乳酸谱是否可以用来得出一种简单的、临床适用的决策算法，以先发制人的方式指导治疗，并可能识别诺伍德手术后选择性体外生命支持的患者。方法：我们回顾分析了2002年3月至2008年5月期间在我们机构接受改良Norwood手术的所有患者。所有患者均接受了右室-肺动脉搭桥术。排除体肺分流的患者。结果测量包括7天和30天死亡率。所有患者连续测量动脉血乳酸至少72小时。采用条件推理树模型来确定乳酸曲线和其他术前和术中危险因素在选择幸存者方面的区分值。结果：共纳入221例患者。ICU 7天病死率为26/219(11.8%)，30天病死率为35/219(15.8%)。有21人在病程间死亡。死亡率模型表明，无法清除血乳酸水平
Objective: Optimisation of Norwood physiology, with focus on systemic perfusion, has beneficial effects on haemodynamic stability and perioperative mortality following the Norwood procedure for hypoplastic left heart syndrome. Early identification of high-risk patients during the postoperative phase might allow for institution of alternative management strategies with the possibility of avoiding poor outcome. Several studies have suggested that arterial blood lactate level, as an index of systemic perfusion and oxygen delivery, can to some extent predict mortality following paediatric cardiac surgery, though these studies have included heterogeneous groups of patients with only few Norwood patients. We sought to determine whether the blood lactate profile could be used to derive a simple, clinically applicable decision algorithm to direct therapy in a pre-emptive manner and perhaps identify patients for elective extracorporeal life support following the Norwood procedure. Methods: We retrospectively analysed all patients at our institution who had undergone modified Norwood procedures between March 2002 and May 2008. All patients had received right ventricle-pulmonary artery conduits. Patients with systemic-pulmonary shunts were excluded. Outcome measures included 7-day and 30-day mortality. Serial arterial blood lactate measurements were taken in all patients for at least 72 h. Conditional inference tree modelling was used to determine the discriminatory value of the lactate profile and other pre- and intra-operative risk factors in terms of selecting survivors. Results: As many as 221 patients were included. The 7-day ICU mortality was 26/219 (11.8%) with total 30-day mortality of 35/219 (15.8%). There were 21 interstage deaths. Mortality modelling demonstrated that an inability to clear blood lactate levels to