心脏术后体外膜肺支持成人患者乳酸水平对临床后果的预测分析  

The analysis of the lactate level of adult patients during the extracorporeal membrane oxygenation support as the predictor for the clinical result after cardiac surgery

作　　者：蒋璇[1] 谷天祥[1] 吴利民[1] 修宗谊[1] 王春[1] 师恩祎[1] 

机构地区：[1]中国医科大学附属第一医院心脏外科,沈阳110001

出　　处：《心血管外科杂志（电子版）》2015年第4期4-7,共4页Journal of Cardiovascular Surgery(Electronic Edition)

摘　　要：目的分析心脏外科手术术后体外膜式氧合支持过程中乳酸水平可否作为预测体外膜肺支持患者后果的有效指标。方法回顾性分析2013年1月至2014年9月31例接受体外膜肺支持的成人患者的病例资料。结果患者平均年龄55.4岁（37-69岁）,其中男14例,女17例,均为心脏手术术后因心脏功能衰竭或呼吸功能衰竭接受体外膜肺支持,其中22例成功脱机,脱机率71.0%,16例（51.6%）完全康复出院,9例（29.0%）未脱机。平均辅助时间为71.6 h（24-148 h）,辅助过程中每2 h行血气分析,监测乳酸水平,其中生存组患者乳酸水平为（2.14±0.81）mmol/L,与死亡组[（4.48±1.24）mmol/L]比较差异具有统计学意义（P〈0.01）,辅助时间在死亡组虽然长于生存组,但差异无统计学意义（P=0.11）。乳酸水平≥4 mmol/L患者死亡率为70%,〈4 mmol/L死亡率为38.1%,差异具有统计学意义（P〈0.01）。结论在体外膜肺支持的心肺衰竭患者中的乳酸水平可以作为患者死亡率的预测指标之一,高乳酸水平往往伴随着较低的脱机率和较高的死亡率。Objective To analyze whether the lactate levels during the postoperative extracorporeal membrane oxygenation support period could be the effective predictor for patients＇ outcomes. Methods A retrospective analysis of 31 adult patients who accepted extracorporeal membrane oxygenation support from January2013 to September 2014 was made. Results Mean age was 55. 4 years（ 37-69 years old）,including 14 males and17 females,patients who received cardiac surgery due to postoperative heart failure or respiratory failure accepted extracorporeal membrane oxygenation support,including 22 cases who weaned successfully（ 71. 0%）,16 cases（ 51. 6%） were discharged,9 cases（ 29. 0%） did not weaned. The average support time was 71. 6 hours（ 24-148hours）,the bloodgas and lactate levels were monitored every two hours during the support period,lactic level in survival group was（ 2. 14 ± 0. 81） mmol / L,compared with the death group [（ 4. 48 ± 1. 24） mmol / L],there was statistical difference（ P〈0. 01）,the support time was longer in the death group,but there was no statistically significant difference between the two groups（ P = 0. 11）. When the lactate level was above 4 mmol / L,patients＇ mortality rate was 70%,while when the lactate leve was lower than 4 mmol / L,the mortality rate was 38. 1%,there was statistical difference（ P〈0. 01）. Conclusions The lactate levels in patients with cardiopulmonary failure need extracorporeal membrane oxygenation support can be useful and as one of the predictors of mortality. Patients with high lactate level are often accompanied with poor result and high mortality.

关 键 词：心脏外科手术 体外膜氧合作用 乳酸 死亡率 

分 类 号：R654.2[医药卫生—外科学]