Early markers of major adverse events in children after cardiac operations
Early markers of major adverse events in children after cardiac operations
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DOI：
10.1016/s0022-5223(97)70018-7
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发表时间：
1997-12-01
影响因子：
6
通讯作者：
Karl, TR
中科院分区：
文献类型：
--
作者：
Duke, T;Butt, W;Karl, TR
目的：本研究的目的是确定预测重症监护病房儿童心脏手术后主要不良事件的生理学变量。方法：采用队列观察性研究。在入住重症监护病房时以及4、8、12和24小时后记录以下变量：平均动脉压、心率、心脏指数、氧输送、混合静脉血氧饱和度、碱差、血乳酸、胃粘膜内pH、二氧化碳差(动脉二氧化碳分压与胃腔内二氧化碳分压之差)和趾心温度梯度。主要不良事件被前瞻性地确定为心脏骤停、需要紧急开胸、发生多器官衰竭和死亡。结果：90例儿童纳入研究，12例发生严重不良事件，4例死亡。在入住重症监护病房时，血乳酸水平、平均动脉压和体外循环持续时间是唯一显著的、独立的重大不良事件预测因子。严重不良事件发生的优势比(95%可信区间)为5.1(1.2~22.1)，入院低血压为2.3(0.5~9.8)，体外循环时间大于150分钟为13.7(3.3~57.2)。入院后4小时的乳酸和二氧化碳差值、入院后8小时的乳酸和碱缺乏是独立显著的预测因素。4h和8h血乳酸水平>4 mm ol/L的主要不良事件发生的优势比分别为8.3(1.8~38.4)和9.3(1.9~11.3)。在前23小时内，心输出量、氧输送、混合静脉血氧饱和度、脚趾核心温度梯度或心率都不是主要不良事件的显著预测因素。结论：在我们目前的治疗策略的竞争中，体外循环时间和术后早期测量的血乳酸水平是预测即将发生的主要不良事件的最好指标。
Objectives: The purpose of this study was to determine the physiologic variables that predict major adverse events in children in the intensive care unit after cardiac operations. Methods: A cohort observational study was conducted. At the time of admission to the intensive care unit and 4, 8, 12, and 24 hours later the following variables were recorded: mean arterial pressure, heart rate, cardiac index, oxygen delivery, mixed venous oxygen saturation, base deficit, blood lactate, gastric intramucosal pH, carbon dioxide difference (the difference between arterial carbon dioxide tension and gastric intraluminal carbon dioxide tension), and toe-core temperature gradient. Major adverse events were prospectively identified as cardiac arrest, need for emergency chest opening, development of multiple organ failure, and death. Results: Ninety children were included in the study; 12 had major adverse events and there were 4 deaths. Blood lactate level, mean arterial pressure, and duration of cardiopulmonary bypass were the only significant, independent predictors of major adverse events when measured at the time of admission to the intensive care unit. The odds ratio (95% confidence intervals) for major adverse events if a lactate level was greater than 1.5 mmol/L was 5.1 (1.2 to 22.1), for admission hypotension 2.3 (0.5 to 9.8), and for a cardiopulmonary bypass time greater than 150 minutes 13.7 (3.3 to 57.2). Four hours after admission lactate and carbon dioxide difference, and 8 hours after admission lactate and base deficit, were independently significant predictors. The odds ratios for major adverse events if the blood lactate level was greater than 4 mmol/L at 4 and 8 hours were 8.3 (1.8 to 38.4) and 9.3 (1.9 to 11.3), respectively. At no time in the first 23 hours were cardiac output, oxygen delivery, mixed venous oxygen saturation, toe-core temperature gradient, or heart rate significant predictors of major adverse events. Conclusions: In the contest of our current treatment strategies, the duration of cardiopulmonary bypass and blood lactate level, measured in the early postoperative period, were the best predictors of impending major adverse events.