■高乳酸血症与体外循环(CPB)后预后的关系存在争议,一些研究忽视了严重高乳酸血症患者乳酸性酸中毒的存在。本研究探讨了乳酸性酸中毒(LA)与体外循环后多器官功能障碍综合征(MODS)发生之间的关系。
本研究是对2017年2月至2018年8月期间接受心脏手术的患者进行的事后分析,并参与了台州医院的一项前瞻性研究。数据收集时间:ICU入院(H0),入院后4、8、12、24和48小时。CPB后血乳酸水平逐渐升高,在H8达到峰值,然后逐渐降低。患者被分组为LA,高乳酸血症(HL),根据ICU入院后8小时的血液检查结果和正常对照(NC)。术前基础,围手术期,比较3组术后情况,以及术后灌注和氧代谢指标。
■有22个(19%),73(64%),洛杉矶有19名(17%)患者,HL,和NC组,分别。LA组APACHEⅡ(24h)和SOFA(24h)评分最高(P<0.05)。LA组ICU停留时间最长(48.5(42.5,50)h),与HL(27(22,48)h)和NC(27(25,46)h)组比较(P=0.012)。LA组MODS发生率最高(36%),与HL组(14%)和NC组(5%)相比(P=0.015)。在洛杉矶集团,氧提取率(O2ER)低于HL组(31.3(24.8,37.6)%)和NC组(31.3(29.0,35.4)%)(P=0.018)。在单变量分析中,患者年龄(OR=1.054,95%CI[1.003-1.109],P=0.038),洛杉矶小组(vs.NC组,(OR=10.286,95%CI[1.148-92.185],P=0.037),和H8时的ΔPCO2(OR=1.197,95%CI[1.022-1.401],P=0.025)是CPB后MODS的危险因素。
■我们推测CPB后乳酸性酸中毒与MODS之间存在相关性。此外,应在CPB后对LA进行强化监测。
UNASSIGNED: The relationship between hyperlactatemia and prognosis after cardiopulmonary bypass (CPB) is controversial, and some studies ignore the presence of lactic acidosis in patients with severe hyperlactacemia. This study explored the association between lactic acidosis (LA) and the occurrence of multiple organ dysfunction syndrome (MODS) after cardiopulmonary bypass.
UNASSIGNED: This study was a post hoc analysis of patients who underwent cardiac surgery between February 2017 and August 2018 and participated in a prospective study at Taizhou Hospital. The data were collected at: ICU admission (H0), and 4, 8, 12, 24, and 48 h after admission. Blood lactate levels gradually increased after CPB, peaking at H8 and then gradually decreasing. The patients were grouped as LA, hyperlactatemia (HL), and normal control (NC) based on blood test results 8 h after ICU admission. Basic preoperative, perioperative, and postoperative conditions were compared between the three groups, as well as postoperative perfusion and oxygen metabolism indexes.
UNASSIGNED: There were 22 (19%), 73 (64%), and 19 (17%) patients in the LA, HL, and NC groups, respectively. APACHE II (24h) and SOFA (24h) scores were the highest in the LA group (P < 0.05). ICU stay duration was the longest for the LA group (48.5 (42.5, 50) h), compared with the HL (27 (22, 48) h) and NC (27 (25, 46) h) groups (P = 0.012). The LA group had the highest incidence of MODS (36%), compared with the HL (14%) and NC (5%) groups (P = 0.015). In the LA group, the oxygen extraction ratio (O2ER) was lower (21.5 (17.05, 32.8)%) than in the HL (31.3 (24.8, 37.6)%) and the NC group (31.3 (29.0, 35.4) %) (P = 0.018). In the univariable analyses, patient age (OR = 1.054, 95% CI [1.003-1.109], P = 0.038), the LA group (vs. the NC group, (OR = 10.286, 95% CI [1.148-92.185], P = 0.037), and ΔPCO2 at H8 (OR = 1.197, 95% CI [1.022-1.401], P = 0.025) were risk factor of MODS after CPB.
UNASSIGNED: We speculated that there was correlation between lactic acidosis and MODS after CPB. In addition, LA should be monitored intensively after CPB.