Shime N, Kageyama K, Ashida H, Ueda M, Kitamura Y, Tanaka Y
Pediatric Intensive Care Unit, Kyoto Prefectural Children's Research Institute, Kyoto Prefectural University of Medicine, Kyoto 602-0841.
Masui. 2001 Jul;50(7):752-7.
Measuring arterial lactate concentration is a prompt, easy and relatively non-invasive way to estimate tissue oxygen metabolism. We evaluated whether perioperative levels of the arterial lactate concentrations can reflect the general severity of a pediatric patient's condition. A consecutive series of 112 patients, aged 5 days to 17 years (median age: 12 months), admitted to our pediatric intensive care unit (PICU) following cardiac surgery under cardiopulmonary bypass were studied. Arterial blood lactate concentration was measured preoperatively, immediately upon termination of the cardiopulmonary bypass (postCPB), immediately following the operation, and 16th hours postoperatively (D1). Trends within arterial lactate concentrations were examined in relation to mortality rates, the duration of PICU stays and the patient's ages. The studied population had a mortality rate of 5.7% (6 patients). Lactate levels increased significantly and exceeded 4.0 mmol.l-1 during postCPB measurements in a majority of the patients. The increases in lactate levels are affected by the changes in interorgan blood flow, blood glucose levels and/or blood pH in addition to the effects of the CPB-priming lactated Ringer's solution. Thus, higher cut off values have to be determined, and lower probabilities assigned, when using postCPB lactate levels to predict the severity of an outcome. Significantly and sustained increases in D1 lactate levels were noted in neonates, patients with longer PICU stays (> 15 days) and those died later. Hyperlactemia greater than 2.2 mmol.l-1 at D1 predicted death with a sensitivity of 82% and a specificity of 72%. The measurement of early postoperative lactate levels, reflecting postoperative ability to eliminate intraoperative hyperlactemia, is a better way of assessing the severity of a pediatric patient's condition following cardiac surgery. The ideal time to measure early postoperative lactate levels should be determined by further research.
测量动脉血乳酸浓度是一种快速、简便且相对无创的评估组织氧代谢的方法。我们评估了围手术期动脉血乳酸浓度水平是否能反映儿科患者病情的总体严重程度。对112例年龄在5天至17岁（中位年龄：12个月）的连续患者进行了研究，这些患者在体外循环心脏手术后入住我们的儿科重症监护病房（PICU）。在术前、体外循环结束即刻（体外循环后）、术后即刻以及术后16小时（第1天）测量动脉血乳酸浓度。研究了动脉血乳酸浓度的变化趋势与死亡率、PICU住院时间以及患者年龄之间的关系。研究人群的死亡率为5.7%（6例患者）。大多数患者在体外循环后测量时乳酸水平显著升高并超过4.0 mmol/L。除了体外循环预充的乳酸林格液的影响外，乳酸水平的升高还受器官间血流变化、血糖水平和/或血液pH值变化的影响。因此，在使用体外循环后乳酸水平预测预后严重程度时，必须确定更高的临界值，并赋予更低的概率。在新生儿、PICU住院时间较长（>15天）以及后期死亡的患者中，第1天乳酸水平显著且持续升高。术后第1天血乳酸水平高于2.2 mmol/L预测死亡的敏感性为82%，特异性为72%。测量术后早期乳酸水平，反映术后消除术中高乳酸血症的能力，是评估心脏手术后儿科患者病情严重程度的更好方法。术后早期乳酸水平的理想测量时间应通过进一步研究确定。
