颅脑术后高乳酸血症循环容量评估及ICU相关预后观察  

Evaluation of circulation volume of patients with hyperlactatemia after craniocerebral surgery and ICU prognosis observation

作　　者：李静超[1] 姚明丽 王玉芳[1] 王凌雁[1] 欧阳彬[1] 管向东[1] Li Jingchao;Yao Mingli;Wang Yufang;Wang Lingyan;Ouyang Bin;Guan Xiangdong(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：《中国中西医结合急救杂志》2020年第1期92-96,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家临床重点专科建设项目(2011-872)。

摘　　要：目的探讨颅脑术后患者高乳酸血症与循环容量及重症监护治疗(ICU)预后的关系.方法选择2018年12月至2019年3月中山大学附属第一医院神经外科ICU(NSICU)择期颅脑术后患者.采用Pearson相关系数或Spearman系数描述术后初始动脉血乳酸(Lac)与即时循环容量指标〔包括平均动脉压(MAP)、中心静脉压(CVP)、自主呼吸条件下下腔静脉(IVC)直径及IVC塌陷指数(IVC-CI)〕的相关关系.纳入术中可能对ICU转归有影响的指标〔如术后机械通气时间、人工气道保留时间、意识恢复时间、NSICU住院时间、转出ICU时格拉斯哥昏迷评分(GCS)〕为校正因素,采用线性(连续变量)或Logistic(分类变量)回归模型进行多因素分析,探讨Lac对ICU预后的影响.结果共纳入162例患者,其中96例有完整的初始动脉血Lac以及循环容量评估资料,其余49例未记录CVP或IVC,17例在机械通气条件下测量IVC.相关性分析显示:96例患者术后初始动脉血Lac与即时MAP、CVP、IVC最大直径(IVCmax)、IVC-CI等容量指标无相关性(r值分别为-0.065、-0.001、-0.023、-0.005,P值分为别0.531、0.994、0.821、0.961);96例患者高乳酸血症发生率高达94.79%(91/96),仅2例(2.08%)存在循环容量不足.IVC-CI<40%组(74例)和IVC-CI≥40%组(22例)患者Lac水平比较差异无统计学意义[4.10(3.10,5.10)mmol/L比5.05(3.10,5.80)mmol/L,P=0.456].纳入的162例患者术后初始动脉血Lac水平为4.10(2.60,5.28)mmol/L,所有患者均最终顺利转出ICU.多因素回归分析显示:高乳酸血症对术后机械通气时间〔95%可信区间(95%CI)为-0.045~0.061,P=0.771〕、人工气道保留时间(95%CI为-0.086~0.074,P=0.884)、意识恢复时间(95%CI为-0.046~0.091,P=0.516)、NSICU住院时间(95%CI为-0.056~0.041,P=0.772)、转出ICU时GCS评分(95%CI为0.725~1.299,P=0.841)均无显著影响;年龄对人工气道保留时间(95%CI为0.023~0.323,P=0.026)和意识恢复时间(95%CI为0.051~0.309,P=0.007)有明显影响;手术时间对人工气�Objective To explore the relationship between hyperlactatemia and circulation volume index and ICU prognosis in patients after craniocerebral surgery.Methods Patients who underwent selective craniocerebral surgery in the neurosurgery intensive care unit(NSICU)of the First Affiliated Hospital,Sun Yat-sen University from December 2018 to March 2019 were enrolled.Pearson correlation coefficient or Spearman coefficient was used to describe the correlation between initial artery lactate(Lac)and real-time volume indexes[including mean arterial pressure(MAP),central venous pressure(CVP),diameter of inferior vena cava(IVC)during spontaneous respiration,and IVC collapse index(IVC-CI)].The indexes in operation those may affect the ICU prognosis[such as postoperative mechanical ventilation time,artificial airway retention time,consciousness recovery time,NSICU hospitalization time,and Glasgow Coma Score(GCS)when transferred out of ICU]were included as correction factors,and linear(continuous variable)or Logistic(classification variable)regression models were used for multivariate analysis to explore the effect of Lac on ICU prognosis.Results A total of 162 patients were included,of which 96 cases had complete initial artery Lac and circulation volume assessment information.The other 49 cases had no CVP or IVC data,and IVC was measured under mechanical ventilation in 17 cases.The correlation analysis showed that there was no significant correlation between the initial artery Lac and MAP,CVP,max diameter of IVC(IVCmax),IVC-CI(r=-0.065,-0.001,-0.023,-0.005,P=0.531,0.994,0.821,0.961).The incidence of hyperlactatemia was as high as 94.79%(91/96)in the 96 patients and only 2(2.08%)of them had insufficent circulatory volume.There was no significant statistical difference in the Lac level of patients with IVC-CI<40%(n=74)and≥40%(n=22)(P=0.456).The mean initial artery Lac level of 162 patients was 4.10(2.60,5.28)mmol/L,and all patients were successfully transferred out of the ICU finally.The multivariate regression analysis showed

关 键 词：颅脑手术 高乳酸血症 循环容量 ICU转归 

分 类 号：R47[医药卫生—护理学]