动脉血乳酸对心脏术后患者病情的评估作用  

Effect of Arterial Blood Lactic Acid on Disease Condition Evaluation of Postcardiotomy Patients

作　　者：王显悦[1] 毕生辉[1] 王晓武[1] 张卫达[1] 梅鲁刚[1] 梁爱琼[1] 徐宇[1] 林曦[1] 

机构地区：[1]广州军区广州总医院心血管外科,广东广州510010

出　　处：《华南国防医学杂志》2012年第3期223-225,共3页Military Medical Journal of South China

基　　金：广东省科技计划项目(2009B060700118);广州市科技计划重点项目(2011J4100021)

摘　　要：目的明确动脉血乳酸(lactate,LAC)对于心脏术后患者的病情评估作用。方法 2011-03/2011-10月间,随机抽取62例心脏术后患者,选择入监护室即时动脉血乳酸低于2.0mmol/L的30例患者分为低乳酸组,余32例为高乳酸组。比较两组患者呼吸机辅助时间、监护室滞留时间以及血管活性药物和碱性药物使用情况。观察两组患者术后恢复情况和动脉血乳酸、酸碱度和碱剩余的变化趋势。结果低乳酸组1例患者术后左肺不张;高乳酸组1例患者因术后低心排综合征死亡。两组患者手术后呼吸机辅助时间、监护室滞留时间有统计学差异(P<0.05)。高乳酸组患者手术后血管活性药物、碱性药物使用频次较高(P<0.05),手术后动脉血乳酸、酸碱度(pH)和碱剩余(base excess,BE)波动较大,术后5 h为波动最高峰,术后15～20 h逐渐恢复正常。结论动脉血乳酸对体外循环心脏术后患者病情有一定评估作用,动脉血乳酸较高患者术后早期病情不稳定,需要更多的药物维护生命体征和内环境稳定,术后恢复较慢。Objective To identify the effect of arterial blood lactic acid on disease condition evaluation of postcardiotomy patients.Methods Between March 2011 and October 2011,62 postcardiotomy patients were randomly divided into two groups according to their arterial blood lactic acid levels.The low lactic acid group consisted of 30 patients with LAC less than2.0 mmol/L and the hyperlactatemia group consisted of the other 32 patients.The length of ICU stay,ventilation time and vasoactive agent and alkaline drug use were compared between two groups.The recovery of patients and variation tendency of arterial blood lactic acid,pH and base excess（BE） were observed.Results There was one case with left pulmonary atelectasis in low lactic acid group and one case died of low output syndrome in hyperlactatemia group.Compared with low lactic acid group,hyperlactatemia group had longer ventilation time and length of ICU stay,and higher frequency of vasoactive agent and alkaline drug use（P0.05）.Hyperlactatemia group had a greater fluctuation of postoperative arterial blood lactic acid levels,pH and BE,which were most obvious at 5 hours after operation and regressed gradually to the normal levels at 15-20 hours after operation.Conclusion The arterial blood lactic acid level can be used to evaluate disease condition of postcardiotomy patients to a certain extent.Patients with high level of arterial blood lactic acid have an unstable disease condition early after operation,need more drugs to maintain vital sign and homeostasis and longer time for postoperative recovery.

关 键 词：乳酸 心脏术后 病情评估 

分 类 号：R454.1[医药卫生—治疗学]