A型主动脉夹层患者术后高乳酸血症的危险因素  

Risk factors for postoperative hyperlactatemia in patients with type A aortic dissection

作　　者：徐红党 张志东[2] 林洪启[1] 赵亮[1] 邱林[1] 郎志斌[1] 王旭[1] 张加强[1] 程兆云[2] 高传玉[3] Xu Hongdang;Zhang Zhidong;Lin Hongqi;Zhao Liang;Qiu Lin;Lang Zhibin;Wang Xu;Zhang Jiaqiang;Cheng Zhaoyun;Gao Chuanyu(Department of Anesthesiology,Heart Centre of Henan Provincial People′s Hospital Central China Fuwai Hospital Zhengzhou University Central China Fuwai Hospital,Zhengzhou 450003,China;Department of Cardiac Surgery,Heart Centre of Henan Provincial People′s Hospital Central China Fuwai Hospital Zhengzhou University Central China Fuwai Hospital,Zhengzhou 450003,China;Department of Cardiology,Heart Centre of Henan Provincial People′s Hospital Central China Fuwai Hospital Zhengzhou University Central China Fuwai Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心脏中心,华中阜外医院,郑州大学华中阜外医院麻醉科,450003 [2]河南省人民医院心脏中心,华中阜外医院,郑州大学华中阜外医院心外科,450003 [3]河南省人民医院心脏中心,华中阜外医院,郑州大学华中阜外医院心内科,450003

出　　处：《中华麻醉学杂志》2019年第9期1055-1057,共3页Chinese Journal of Anesthesiology

基　　金：河南省科技攻关计划项目(192102310375,172102310101);河南省医学科技攻关计划项目(2018020459)。

摘　　要：目的筛选A型主动脉夹层患者术后高乳酸血症的危险因素。方法回顾性收集2012年1月至2017年10月行心血管手术的A型主动脉夹层患者的病历资料。根据术后8 h是否发生高乳酸血症(血乳酸≥6 mmol/L)分为高乳酸血症组和非高乳酸血症组。将单因素分析差异具有统计学意义的变量进行logistic回归分析,筛选该类患者术后高乳酸血症的危险因素。结果共纳入患者295例,其中80例发生了术后高乳酸血症,发生率为27.1%。logistic回归分析显示,术前急性心包填塞、术中深低温停循环时间>35 min和术后8 h内大量输血(>1000 ml)是A型主动脉夹层患者术后高乳酸血症的独立危险因素。结论术前急性心包填塞、术中深低温停循环时间>35 min和术后8 h内大量输血是A型主动脉夹层术后高乳酸血症的独立危险因素。Objective To identify the risk factors for postoperative hyperlactatemia in the patients with type A aortic dissection.Methods Medical records of patients with type A aortic dissection who underwent cardiovascular surgery from January 2012 to October 2017 were retrospectively collected.The patients were divided into hyperlactatemia group and non-hyperlactatemia group according to the occurrence of hyperlactatemia(blood lactic acid≥6 mmol/L)at 8 h after surgery.The variables of which P values were less than 0.05 in univariate analysis would enter the logistic regression analysis to stratify the risk factors for postoperative hyperlactatemia in this type of patients.Results A total of 295 patients were included,of which 80 cases developed postoperative hyperlactatemia,and the incidence was 27.1%.Logistic regression analysis showed that preoperative acute pericardial tamponade,intraoperative deep hypothermic circulatory arrest time(>35 min)and massive transfusion of blood(>1000 ml)within 8 h after operation were independent risk factors for postoperative hyperlactatemia in the patients with type A aortic dissection.Conclusion Preoperative acute pericardial tamponade,intraoperative deep hypothermic circulatory arrest time>35 min and massive transfusion of blood(>1000 ml)within 8 h after operation are independent risk factors for postoperative hyperlactatemia in the patients with type A aortic dissection.

关 键 词：动脉瘤 夹层 高乳酸血症 危险因素 

分 类 号：R654.3[医药卫生—外科学]