Outcome with high blood lactate levels during cardiopulmonary bypass in adult cardiac operation
Outcome with high blood lactate levels during cardiopulmonary bypass in adult cardiac operation
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DOI：
10.1016/s0003-4975(00)02160-3
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发表时间：
2000-12-01
影响因子：
4.6
通讯作者：
Cartier, R
中科院分区：
文献类型：
--
作者：
Demers, P;Elkouri, S;Cartier, R
背景：体外循环（CPB）期间高血乳酸水平与组织灌注不足有关，可能导致术后并发症或死亡。本研究的目的是确定CPB期间血乳酸水平与围手术期发病率和死亡率之间的关系。我们回顾了1，376例在体外循环下接受心脏手术的患者。排除术前血乳酸水平异常的患者（n = 101）。记录CPB期间的血乳酸浓度、临床数据和围手术期事件。结果CPB期间227例患者（18.0%）的血乳酸峰值水平≥ 4.0 mmol/L。该组患者的术后死亡率高于CPB期间血乳酸峰值水平低于4.0 mmol/L的患者（11.0% vs 1.4%; p < 0.001，相对风险[RR] = 9.0）。CPB期间乳酸水平升高的患者中有29.5%发生术后血流动力学不稳定，而乳酸水平较低的患者中有10.9%发生术后血流动力学不稳定（p < 0.001，RR = 3.4）。总体而言，两组中分别有43.2%和21.8%的患者发生了严重术后并发症（p < 0.001，RR = 2.7）。Logistic回归分析显示，CFB期间血乳酸峰值水平≥ 4.0 mmol/L与术后死亡率（p = 0.0001）和发病率（p = 0.013）密切相关。CFB期间血乳酸浓度≥ 4.0 mmol/L可确定术后发病率和死亡率风险增加的患者亚组。(Ann Thorac Surg 2000;70：2082-6）（C）2000年，胸外科医师协会。
Background High blood lactate levels during cardiopulmonary bypass (CPB) are associated with tissue hypoperfusion and may contribute to postoperative complications or death. The objective of this study was to determine an association between blood lactate levels during CPB and perioperative morbidity and mortality.Methods. We reviewed 1,376 patients who underwent cardiac operation with CPB. Patients with abnormal preoperative blood lactate levels were excluded (n = 101). Blood lactate concentration during CPB, clinical data, and perioperative events were recorded..Results. Peak blood lactate levels of 4.0 mmol/L, or higher during CPB were present in 227 patients (18.0%). Postoperative mortality was higher in this group than in the patients who had peak blood lactate levels of less than 4.0 mmol/L during CPB (11.0% versus 1.4%; p < 0.001, relative risk [RR] = 9.0). Postoperative hemodynamic instability occurred in 29.5% of patients with elevated levels of lactate during CPB compared with 10.9% of patients with lower lactate levels (p < 0.001, RR = 3.4). Overall, major postoperative complications occurred in 43.2% and 21.8% of patients in each group, respectively (p < 0.001, RR = 2.7). Logistic regression analysis revealed that peak blood lactate levels of 4.0 mmol/L or higher during CFB were strongly associated with postoperative mortality (p = 0.0001) and morbidity (p = 0.013).Conclusions. Blood lactate concentration of 4.0 mmol/L or higher during CFB identifies a subgroup of patients with increased risk of postoperative morbidity and mortality. (Ann Thorac Surg 2000;70:2082-6) (C) 2000 by The Society of Thoracic Surgeons.