早期乳酸清除率评估体外循环心脏手术患者预后
조기유산청제솔평고체외순배심장수술환자예후
Early lactate clearance rate in assessing the prognosis of patients with postcardiac surgery undergoing cardiopulmonary bypass
  • 万方数据
    中国综合临床 중국종합림상
    CLINICAL MEDICINE OF CHINA
    2012年 4期 340-343 ,共4页

    汪华玲%何胜虎%徐日新%陈齐红%朱亚彬%季方兵

    왕화령%하성호%서일신%진제홍%주아빈%계방병

    心脏术后%乳酸清除率%预后 心髒術後%乳痠清除率%預後
    심장술후%유산청제솔%예후
    Postcardiac surgery%Lactate clearance%Prognosis
    目的 探讨早期乳酸清除率与体外循环心脏术后患者预后的关系.方法 前瞻性观察并收集我院2006年3月至2010年2月体外循环心脏手术73例患者的临床资料.收集资料包括:(1)术前因素:性别、年龄、术前诊断、术前NYHA分级、APACHEⅡ评分及左心室舒张末期内径.(2)术中因素:手术时间、主动脉阻断时间.(3)术后因素:术后出血量、机械通气时间以及术后6h血流动力学及氧代谢指标:心率(HR)、中心静脉压(CVP)、肺毛细血管嵌顿压(PAWP)、心输出量指数(CI)、动脉血乳酸、6h动脉血乳酸清除率、动脉血氧分压(PaO2)、混合静脉血氧饱和度(SvO2)、氧输送指数(DO2I)、氧耗指数(VO2I)及全身氧提取率(O2ext).将患者分为存活组和死亡组,高乳酸清除率组(乳酸清除率＞30％)和低乳酸清除率组.首先应用单因素相关分析,筛选出两组有统计学意义的参数,然后再对这些参数进行多元回归分析,从中找出体外循环心脏术后死亡的独立危险因素.结果 高乳酸清除率组病死率[4.55％ (2/44)]明显低于低乳酸清除率组[34.48％( 10/29)],差异有统计学意义(x2=11.889,P＜0.01).单因素相关分析显示存活组与死亡组间APACHEⅡ评分[(16.9±2.9)分比(19.2±2.6)分,t=2.537],左心室舒张末期内径[(53.9±5.6)mm比(63.8±4.6) mm,t=5.847],主动脉阻断时间[(101.2±34.2)min比(122.7±22.7) min,t=2.078],术后出血量[(464.0±158.8)ml比(603.2±159.5)ml,t =2.773],机械通气时间[(22.6±5.1)h比(28.8±5.2)h,t =3.857],动脉血乳酸[(3.5±1.3) mmol/L比(5.1±1.5) mmol/L,t=3.912],动脉血乳酸清除率[(38.8±17.4)％比(14.6±9.7)％,t =4.846],SvO2[(69.1±4.2)％比(59.2±6.9)％,t=5.847]差异有统计学意义(P＜0.05或P＜0.001).多元回归分析显示动脉血乳酸清除率、左心室舒张末期内径是体外循环心脏术后死亡的两个独立危险因素,优势比(OR)分别为7.773 (95％ CI 1.364 ～44.306,P＜0.05),15.186 (95％ CI 2.758～83.162,P＜0.01).结论 早期血乳酸清除率可以作为评价体外循环心脏术后患者预后的重要指标.
    목적 탐토조기유산청제솔여체외순배심장술후환자예후적관계.방법 전첨성관찰병수집아원2006년3월지2010년2월체외순배심장수술73례환자적림상자료.수집자료포괄:(1)술전인소:성별、년령、술전진단、술전NYHA분급、APACHEⅡ평분급좌심실서장말기내경.(2)술중인소:수술시간、주동맥조단시간.(3)술후인소:술후출혈량、궤계통기시간이급술후6h혈류동역학급양대사지표:심솔(HR)、중심정맥압(CVP)、폐모세혈관감돈압(PAWP)、심수출량지수(CI)、동맥혈유산、6h동맥혈유산청제솔、동맥혈양분압(PaO2)、혼합정맥혈양포화도(SvO2)、양수송지수(DO2I)、양모지수(VO2I)급전신양제취솔(O2ext).장환자분위존활조화사망조,고유산청제솔조(유산청제솔＞30％)화저유산청제솔조.수선응용단인소상관분석,사선출량조유통계학의의적삼수,연후재대저사삼수진행다원회귀분석,종중조출체외순배심장술후사망적독립위험인소.결과 고유산청제솔조병사솔[4.55％ (2/44)]명현저우저유산청제솔조[34.48％( 10/29)],차이유통계학의의(x2=11.889,P＜0.01).단인소상관분석현시존활조여사망조간APACHEⅡ평분[(16.9±2.9)분비(19.2±2.6)분,t=2.537],좌심실서장말기내경[(53.9±5.6)mm비(63.8±4.6) mm,t=5.847],주동맥조단시간[(101.2±34.2)min비(122.7±22.7) min,t=2.078],술후출혈량[(464.0±158.8)ml비(603.2±159.5)ml,t =2.773],궤계통기시간[(22.6±5.1)h비(28.8±5.2)h,t =3.857],동맥혈유산[(3.5±1.3) mmol/L비(5.1±1.5) mmol/L,t=3.912],동맥혈유산청제솔[(38.8±17.4)％비(14.6±9.7)％,t =4.846],SvO2[(69.1±4.2)％비(59.2±6.9)％,t=5.847]차이유통계학의의(P＜0.05혹P＜0.001).다원회귀분석현시동맥혈유산청제솔、좌심실서장말기내경시체외순배심장술후사망적량개독립위험인소,우세비(OR)분별위7.773 (95％ CI 1.364 ～44.306,P＜0.05),15.186 (95％ CI 2.758～83.162,P＜0.01).결론 조기혈유산청제솔가이작위평개체외순배심장술후환자예후적중요지표.
    Objective To investigate the correlation between the prognosis and the early lactate clearance in patients with postcardiac surgery undergoing cardiopulmonary bypass.Methods The clinical data of 73 patients who underwent postcardiotomy undergoing cardiopulmonary bypass in SuBei Hospital of Jiangsu Provience,from March 2006 to February 2010,were prospectively collected and analyzed.The collection data including:( 1 ) Preoperative factors:including gender,age,diagnosis preoperative,NYHA grade,APACHE Ⅱ score and left ventricular end-diastolic diameter.(2) Operative factors:operation time,block aorta time.(3)Postoperation factors:hemorrhage volume,mechanical ventilation time,and factors of hemodynamics and oxygen metabolism at 6 hour postoperative:heart rate(HR),central venous pressure(CVP),pulmonary capilary wedged pressure( PCWP),cardiac output index( CI),arterial blood lactic acid,6 h lactate clearance,partial pressure of oxygen( PO2 ),mixed venous oxygen saturation ( SvO2 ),oxygen delivery index ( DO2I),oxygen consume index (VO2I),oxygen extraction ratio(O2ext).Patients were divided into survival group,control group,high level of lactate clearance group( lactate clearance rate ＞ 30％ ) and low level of lactate clearance group.Firstly,the data analyzed with process of single variable analysis and some parameters,which showed the significant difference,were sorted out from two groups.Then these parameters were put to the Logistic regression analysis.Consequently,the independent risk factors of death of postcardiac surgery could be found.Results The mortality in high lactate clearance group ( 4.55％ [ 2/44 ] ) was significantly less than the low lactate group (34.48％ [ 10/29] ) ( x2 =11.889,P ＜0.01 ).The single variable analysis had shown that there were significant difference on APACHE Ⅱ score ( [ 16.9 ± 2.9 ] vs [ 19.2 ± 2.6 ],t =2.537 ),left ventricular end-diastolic diameter( [ 53.9 ± 5.6 ] mm vs [ 63.8 ± 4.6 ] mm,t =5.847 ),block aorta time ( [ 101.2 ± 34.2 ] min vs [ 122.7 ±22.7 ] min,t =2.078 ),hemorrhage volume( [464.0 ± 158.8 ] ml vs [ 603.2 ± 159.5 ] ml,t =2.773 ),mechanical ventilation time( [ 22.6 ± 5.1 ] h vs [ 28.8 ± 5.2 ] h,t =3.857 ),arterial blood lactic acid ( [ 3.5 ±1.3 ] mmol/L vs [5.1 ± 1.5 ] mmol/L,t =3.912),lactate clearance ( [38.8 ± 17.4]％ vs [ 14.6 ±9.7]％,t =4.846),and SvO2( [69.1 ±4.2]％ vs [59.2 ±6.9]％,t =5.847) (P＜0.05 or P ＜0.001)between survival group and control group.Multiple regression analysis showed that lactate clearance and left ventricular enddiastolic diameter were the two independent risk factors of death,and the odds ratio(OR) were 7.773 (95％ CI 1.364-44.306,P ＜0.05) and 15.186(95％ CI 2.758-83.162,P ＜0.01).Conclusion Early lactate clearance rate can be used as an important indicator to evaluate the prognosis of patients with postcardiac surgery undergoing cardiopulmonary bypass.
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