颅脑肿瘤术后动脉血乳酸升高与手术时间及术中使用外源性糖皮质激素的相关性研究  

Elevated artery lactate after brain tumor craniotomy is associated with surgery duration and exogenous administration of corticosteroids

作　　者：李静超[1] 姚明丽 王凌雁[1] 梅美华 管向东[1] 欧阳彬[1] Li Jingchao;Yao Mingli;Wang Lingyan;Mei Meihua;Guan Xiangdong;Ouyang Bin(Department of Intensive Care Unit,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,Guangdong,China)

机构地区：[1]中山大学附属第一医院重症医学科,广东广州510080

出　　处：《中华危重病急救医学》2019年第10期1247-1251,共5页Chinese Critical Care Medicine

基　　金：国家临床重点专科建设项目(2011-872)。

摘　　要：目的 探讨颅脑肿瘤术后患者高乳酸血症的相关影响因素.方法 选择2018年12月1日至2019年5月20日在中山大学附属第一医院重症医学科(ICU)神经外科ICU(NSICU)行择期颅脑肿瘤(包括胶质瘤、脑膜瘤、听神经鞘瘤)切除术后的患者.统计颅脑肿瘤术后高乳酸血症的发生率;并采用单因素及多因素线性回归分析术后初始动脉血乳酸与手术时间、术中出血量、术中液体总入量、术中乳酸钠林格液输入量、术中尿量、术中液体平衡量、术中外源性糖皮质激素用量及肿瘤类型的相关关系.采用Pearson法分析乳酸与独立相关影响因素的相关性.结果 共纳入148例患者,其中胶质瘤45例(30.41%),脑膜瘤64例(43.24%),听神经鞘瘤39例(26.35%).148例患者术后初始动脉血乳酸明显增高,中位数为4.80(3.68,5.90)mmol/L;其中78例患者(52.70%)动脉血乳酸轻度升高(2 mmol/L<乳酸≤5 mmol/L),61例患者(41.22%)动脉血乳酸明显升高(5 mmol/L<乳酸≤10 mmol/L), 2例患者(1.35%)动脉血乳酸严重升高(>10 mmol/L),仅7例患者(4.73%)动脉血乳酸在正常范围(≤2 mmol/L).单因素分析显示,患者术后初始动脉血乳酸水平与手术时间〔β=0.556,95%可信区间(95%CI)为0.257~0.855,P<0.001〕、术中外源性糖皮质激素总用量(β=0.477, 95%CI为0.174~0.779,P=0.002)呈独立正相关,而与患者肿瘤类型、术中出血量、液体总入量、乳酸钠林格液输入量、尿量及液体平衡量均无显著相关.进一步多因素线性回归分析显示,手术时间(β=0.499,95%CI为0.204~0.795,P=0.001)、术中外源性糖皮质激素总用量(β=0.407,95%CI为0.111~0.703,P=0.008)仍是影响患者术后初始动脉血乳酸水平的独立相关因素.相关性分析显示,动脉血乳酸与手术时间、术中激素总用量均呈正相关(r1=0.289,r2=0.248,均P<0.01).结论 颅脑肿瘤术后初始动脉血乳酸升高与手术时间及术中外源性糖皮质激素使用有关.Objective To study the influential factor of hyperlactatemia after the brain tumor craniotomy.Methods Patients who underwent selective brain tumor(including glioma,meningioma and acoustic schwannoma)craniotomyin the neurosurgery intensive care unit(NSICU)of the First Affiliated Hospital,Sun Yat-sen University from December 1st 2018 to May 20th 2019 were enrolled.The incidence of hyperlactatemia after the brain tumor craniotomy was investigated.Univariate and multivariate linear regression analysis were performed to identify the association of initial artery lactate with the operation duration,the intraoperative blood loss,the total intraoperative fluid infusion,intraoperative ringer lactate fluid infusion,intraoperative urine volume,intraoperative fluid balance,the total intraoperative corticosteroids dosage and the tumor type.Pearson method was used to analyze the correlation between lactate in arterial blood and independent related factors.Results A total of 148 patients were enrolled including 45 patients(30.41%)with glioma,64 patients(43.24%)with meningioma,and 39 patients(26.35%)with acoustic schwannoma.The initial lactate level in arterial blood increased significantly in 148 patients,with a median of 4.80(3.68,5.90)mmol/L.Among them,78 patients(52.70%)had mild elevation of lactate in arterial blood(2 mmol/L<lactate≤5 mmol/L),61 patients(41.22%)had significant elevation of lactate in arterial blood(5 mmol/L<lactate≤10 mmol/L),and 2 patients(1.35%)had serious elevation of artery lactate(>10 mmol/L).And only 7 patients(4.73%)had normal level of lactate in arterial blood(≤2 mmol/L).Univariate analysis showed that initial postoperative artery lactate was positively correlated with the operation duration[β=0.556,95%confidence interval(95%CI)was 0.257-0.855,P<0.001]and the total intraoperative corticosteroids dosage(β=0.477,95%CI was 0.174-0.779,P=0.002).There was no significant correlation between the initial postoperative artery lactate and tumor types,the intraoperative blood loss,the total fluid infus

关 键 词：颅脑肿瘤 高乳酸血症 手术时间 糖皮质激素 

分 类 号：R73[医药卫生—肿瘤]