Kapoor Pm, Mandal B, Chowdhury Uk, Singh Sp, Kiran U
Department of Cardiac Anaesthesia and CTVS, CN Centre, All India Institute of Medical Sciences, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2011 Apr;27(2):225-32. doi: 10.4103/0970-9185.81819.
Myocardial lactate assays have been established as a standard method to compare various myocardial protection strategies. This study was designed to test whether coronary sinus (CS) lactates, pyruvate and lactate-pyruvate (LP) ratio correlates with myocardial dysfunction and predict postoperative outcomes.
This prospective observational study was conducted on 40 adult patients undergoing elective cardiac surgery with the aid of cardiopulmonary bypass (CPB). CS blood sampling was done for estimation of myocardial lactate (ML), pyruvate (MP) and lactate-pyruvate ratio (MLPR) namely: pre-CPB (T(1)), after removal of aortic cross clamp (T(2)) and 30 minutes post-CPB (T(3)).
Baseline myocardial LPR strongly correlated with Troponin-I at T1 (σ: 0.6). Patients were sub grouped according to the median value of myocardial lactate (2.9) at baseline T1 into low myocardial lactate (LML) group, mean (2.39±0.4 mmol/l), n=19 and a high myocardial lactate (HML) group, mean (3.65±0.9 mmol/l), n = 21. A significant increase in PL, ML, MLPR and TropI occurred in both groups as compared to baseline. Patients in HML group had significant longer period of ICU stay. Patients with higher inotrope score had significantly higher ML (T2, T3). ML with a baseline value of 2.9 mmol/l had 70.83% sensitivity and 62.5% specificity (ROC area: 0.7109 Std error: 0.09) while myocardial pyruvate with a baseline value of 0.07 mmol/l has 79.17% sensitivity and 68.75% specificity (ROC area: 0.7852, Std error: 0.0765) for predicting inotrope requirement after CPB.
CS lactate, pyruvate and LP ratio correlate with myocardial function and can predict postoperative outcome.
心肌乳酸测定已成为比较各种心肌保护策略的标准方法。本研究旨在测试冠状窦（CS）乳酸、丙酮酸和乳酸 - 丙酮酸（LP）比值是否与心肌功能障碍相关，并预测术后结果。
本前瞻性观察性研究对40例接受体外循环（CPB）辅助择期心脏手术的成年患者进行。采集CS血样以评估心肌乳酸（ML）、丙酮酸（MP）和乳酸 - 丙酮酸比值（MLPR），即：CPB前（T(1)）、主动脉阻断钳移除后（T(2)）和CPB后30分钟（T(3)）。
基线心肌LPR与T1时的肌钙蛋白 - I密切相关（σ：0.6）。患者根据基线T1时心肌乳酸的中位数（2.9）分为低心肌乳酸（LML）组，均值（2.39±0.4 mmol/l），n = 19和高心肌乳酸（HML）组，均值（3.65±0.9 mmol/l），n = 21。与基线相比，两组的PL、ML、MLPR和TropI均显著增加。HML组患者的ICU住院时间明显更长。使用血管活性药物评分较高的患者ML显著更高（T2，T3）。基线值为2.9 mmol/l的ML预测CPB后血管活性药物需求的敏感性为70.83%，特异性为62.5%（ROC面积：0.7109，标准误差：0.09），而基线值为0.07 mmol/l的心肌丙酮酸预测CPB后血管活性药物需求的敏感性为79.17%，特异性为68.75%（ROC面积：0.7852，标准误差：0.0765）。
CS乳酸、丙酮酸和LP比值与心肌功能相关，并可预测术后结果。
