成人心脏手术围术期严重高乳酸血症的相关因素分析  

Related Factors of Severe Hyperprolactinemia during the Perioperative Period of Adult Cardiac Surgery

作　　者：李天宝 柯英杰 张洪宇[2] 张杰成 章晓华[1] 柯俊 雷迪斯 周成斌[1] LI Tianbao;KE Yingjie;ZHANG Hongyu;ZHANG Jiecheng;ZHANG Xiaohua;KE Jun;LEI Disi;ZHOU Chengbin(Department of Cardiovascular Surgery,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Department of Cardiovascular Surgery,Guangdong Provincial People's Hospital Nanhai Hospital,Foshan,Guangdong 528251,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)心外科,广州510080 [2]广东省人民医院南海医院心外科,广东佛山528251

出　　处：《岭南心血管病杂志》2024年第5期515-520,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨成人心脏手术围术期严重高乳酸血症的特点及相关因素。方法对2019年1月至2022年12月在广东省人民医院接受心脏手术的620例患者围术期资料进行回顾性分析。根据血乳酸峰值浓度分为严重高乳酸血症组(乳酸浓度>10 mmol/L)和对照组(乳酸浓度≤10 mmol/L)。根据是否糖尿病患者、年龄、体外循环(cardiopulmonary bypass,CPB)时间、乳酸浓度升高时间进行分组分析。结果全组发生严重高乳酸血症患者132例,发生率为21.3%,其中严重高乳酸血症组有2例死亡(院内病死率为1.5%)。严重高乳酸血症组与对照组患者在年龄、体质量、术前红细胞比容(HCT)、术中血糖浓度、CPB时间、术后血糖浓度、乳酸浓度、乳酸浓度上升和下降时间、呼吸机辅助时间、住院时间及病死率比较,差异有统计学意义(P<0.05)。年龄≥55岁亚组、CPB时间≥3 h亚组与对照组患者严重高乳酸血症发生率、乳酸峰值下降时间比较,差异有统计学意义(P<0.05)。糖尿病组与对照组患者在入重症监护室(intensive care unit,ICU)时乳酸浓度、乳酸浓度峰值及峰值下降时间点的血糖浓度比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄、术中最低膀胱温度、入ICU乳酸浓度是发生严重高乳酸血症的影响因素(P<0.05)。结论严重高乳酸血症患者病情相对较重,但并不意味着有较高的病死率。针对红细胞压积和乳酸浓度偏高的高龄人群,术前应适度进行液体管理改善组织灌注,术中尽量缩短CPB时间,术后关注入ICU时高乳酸患者及高浓度乳酸的持续时间,积极处理原发病使乳酸浓度尽快降下来。糖尿病患者与非糖尿病患者的乳酸浓度有差异。Objectives To investigating the correlation factors and characteristics of hyperlactatemia during the periop‐erative period of adult cardiac surgery and its related factors.Methods Perioperative data of 620 patients who underwent cardiac surgery from January 2019 to December 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed.They were categorized into severe hyperlactatemia group(concentration of lactate>10 mmol/L)and control group(concentration of lactate≤10 mmol/L)based on peak blood concentration of lactate.Subgroups were analyzed according to whether they were diabetics,age,duration of cardiopulmonary bypass(CPB),and time of lactate elevation.Results Severe hyperlactatemia occurred in 132 patients in the whole group,with an incidence rate of 21.3%,including 2 deaths in severe hyperlactatemia group(in-hospital mortality rate of 1.5%).Patients in severe hyperlactatemia group differed from control group in age,body weight,preoperative hematocrit(HCT),intraoperative glucose value,duration of CPB,postoperative concentration of glucose,concentration of lactate,concentration of lactate rise and fall time,ventilator-assisted duration,hospitalization duration,and mortality rate(P<0.05).There were differences in the rate of severe hyperlactatemia and the time of peak concentration of lactate decline among age≥55 years subgroug,duration of CPB≥3 h subgroup and control group(P<0.05).Diabetics differed from control group in concentration of lactate at the admission to the intensive care unit(ICU),blood concentration of glucose at peak concentration of lactate decline time point(P<0.05).Logistic regression analysis showed that age,minimum intraoperative bladder temperature,and concentration of lactate at the admission to ICU were the influencing factors for the occurrence of severe hyperlactatemia(P<0.05).Conclusions Patients with severe hyperlactatemia are relatively sick,but it does not mean higher mortality.For patients with high erythrocyte pressure product and high concentration of la

关 键 词：心脏手术 高乳酸血症 体外循环 

分 类 号：R654.2[医药卫生—外科学]