Intraoperative lactate levels and postoperative complications of pediatric cardiac surgery
Intraoperative lactate levels and postoperative complications of pediatric cardiac surgery
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DOI：
10.1111/j.1460-9592.2012.03823.x
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发表时间：
2012-08-01
影响因子：
1.7
通讯作者：
Pinheiro Modolo, Norma Sueli
中科院分区：
文献类型：
--
作者：
Alves, Rodrigo Leal;Aragao e Silva, Andre Luiz;Pinheiro Modolo, Norma Sueli
目的：探讨儿童心脏手术围术期动脉血乳酸水平与术后并发症发生的关系。目的：动脉乳酸水平可指示低灌流状态，可作为该人群发病率和死亡率的预后标志。背景：儿科心脏手术的麻醉常在生理状况严重异常的患者身上进行。在术中，血容量、体温、血浆成分和组织血流量发生了显著变化，炎症也随之激活，产生了重要的病理生理后果。方法/材料：以标准化的形式收集有关患者的手术方式和围手术期情况的图表数据。通过优势比和非参数单因素分析，比较出现或不出现术后并发症的患者在术中末期的动脉血乳酸水平，以及与围手术期情况相关的频率。结果：在非体外循环(CPB)手术后，有肾脏并发症的患者入院时动脉血乳酸水平(2.96 mm比1.31 mm)和死亡患者(2.93 mm比1.40 mm)明显升高。在体外循环手术中，心血管(2.90 mm对2.06 mm)、肾脏(3.34对2.33 mm)、呼吸系统(2.98对2.12 mm)和血液系统并发症(2.99对1.95 mm)和死亡(3.38对2.40 mm)也观察到了同样的关联。结论：在儿科心脏手术中，无论有无体外循环，术中动脉乳酸水平升高与低风险和中风险手术的发病率和死亡率高相关。
Objectives: Correlate arterial lactate levels during the intraoperative period of children undergoing cardiac surgery and the occurrence of complications in the postoperative period. Aim: Arterial lactate levels can indicate hypoperfusion states, serving as prognostic markers of morbidity and mortality in this population. Background: Anesthesia for cardiac pediatric surgery is frequently performed on patients with serious abnormal physiological conditions. During the intraoperative period, there are significant variations of blood volume, body temperature, plasma composition, and tissue blood flow, as well as the activation of inflammation, with important pathophysiological consequences. Methods/Materials: Chart data relating to the procedures and perioperative conditions of the patients were collected on a standardized form. Comparisons of arterial lactate values at the end of the intraoperative period of the patients that presented, or not, with postoperative complications and frequencies related to perioperative conditions were established by odds ratio and nonparametric univariate analysis. Results: After surgeries without cardiopulmonary bypass (CPB), higher levels of arterial lactate upon ICU admission were observed in patients who had renal complications (2.96 vs 1.31 mm) and those who died (2.93 vs 1.40 mm). For surgeries with CPB, the same association was observed for cardiovascular (2.90 mm x 2.06 mm), renal (3.34 vs 2.33 mm), respiratory (2.98 vs 2.12 mm) and hematological complications (2.99 vs 1.95 mm), and death (3.38 vs 2.40 mm). Conclusion: Elevated intraoperative arterial lactate levels are associated with a higher morbidity and mortality in low- and medium-risk procedures, with or without CPB, in pediatric cardiac surgery.