体外循环流量：儿童继发房间隔缺损修补术后高乳酸血症的危险因素。

Cardiopulmonary bypass flow rate: a risk factor for hyperlactatemia after surgical repair of secundum atrial septal defect in children.

机构信息

Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, AR, USA.

出版信息

J Thorac Cardiovasc Surg. 2010 Jan;139(1):170-3. doi: 10.1016/j.jtcvs.2009.04.060.

DOI:10.1016/j.jtcvs.2009.04.060

PMID:20106363

Abstract

OBJECTIVE

Early postoperative hyperlactatemia is seen in some children after surgical repair of secundum atrial septal defect despite apparently normal cardiac output. The objective of the study was to investigate the intraoperative risk factors for hyperlactatemia in patients undergoing atrial septal defect repair.

METHODS AND RESULTS

A retrospective review of 68 consecutive patients who underwent isolated atrial septal defect repair at Arkansas Children's Hospital between January 2001 and March 2006 was performed. Perioperative factors in the high lactate group (lactate >3 mmol/L, n = 26) were compared with those in the low lactate group (n = 42). Early hyperlactatemia was seen in 38% of the cohort. The high lactate group showed significantly lower weight-indexed cardiopulmonary bypass flow rate (101 + or - 6.5 mL/kg(-1)/min(-1) vs 131 + or - 6.0 mL/kg(-1)/min(-1), P = .0013), oxygen delivery during cardiopulmonary bypass (mean 12.7 + or - 0. 7 mL/kg(-1)/min(-1) vs 17.0 + or - 1 mL/kg(-1)/min(-1), P = .0009), and higher postoperative glucose (191 + or - 8.6 mg/dL vs 151 + or - 5.4 mg/dL, P = .003) compared with the LL group. Multivariate logistic regression analysis showed that weight-indexed cardiopulmonary bypass flow rate (P = .007) and average mean arterial blood pressure during cardiopulmonary bypass (P = .009) were independent risk factors for postoperative hyperlactatemia. Cardiopulmonary bypass flow rate less than 100 mL/kg(-1)/min(-1) was associated with an odds ratio of 7.67 (95% confidence interval, 1.28-45.86; P = .026) for postoperative hyperlactatemia.

CONCLUSION

Lower weight-indexed cardiopulmonary bypass flow rate is an independent risk factor for early postoperative hyperlactatemia in children after atrial septal defect repair.

摘要

目的

尽管心输出量似乎正常，但一些儿童在接受房间隔缺损修补术后的早期仍会出现高乳酸血症。本研究旨在探讨行房间隔缺损修补术患者术中发生高乳酸血症的危险因素。

方法和结果

对 2001 年 1 月至 2006 年 3 月期间在阿肯色儿童医院行单纯房间隔缺损修补术的 68 例连续患者进行回顾性分析。将高乳酸组（乳酸＞3mmol/L，n=26）和低乳酸组（n=42）的围术期相关因素进行比较。本研究队列中 38%的患者出现早期高乳酸血症。高乳酸组的体重指数校正心肺转流流量显著较低[（101±6.5）mL/（kg·min）比（131±6.0）mL/（kg·min），P=0.0013]，心肺转流期间的氧输送也较低[（平均 12.7±0.7）mL/（kg·min）比（17.0±1.0）mL/（kg·min），P=0.0009]，术后血糖较高[（191±8.6）mg/dL 比（151±5.4）mg/dL，P=0.003]。多变量逻辑回归分析显示，体重指数校正心肺转流流量（P=0.007）和心肺转流期间平均动脉压（P=0.009）是术后高乳酸血症的独立危险因素。心肺转流流量＜100mL/（kg·min）与术后高乳酸血症的比值比为 7.67（95%可信区间，1.28~45.86；P=0.026）。