Alves Rodrigo Leal, Aragão e Silva André Luiz, Kraychete Nadja Cecília de Castro, Campos Guilherme Oliveira, Martins Marcelo de Jesus, Módolo Norma Sueli Pinheiro
São Rafael Hospital, Universidade Federal da Bahia (UFBA), Bahia, Brazil.
Paediatr Anaesth. 2012 Aug;22(8):812-7. doi: 10.1111/j.1460-9592.2012.03823.x. Epub 2012 Mar 12.
Correlate arterial lactate levels during the intraoperative period of children undergoing cardiac surgery and the occurrence of complications in the postoperative period.
Arterial lactate levels can indicate hypoperfusion states, serving as prognostic markers of morbidity and mortality in this population.
Anesthesia for cardiac pediatric surgery is frequently performed on patients with serious abnormal physiological conditions. During the intraoperative period, there are significant variations of blood volume, body temperature, plasma composition, and tissue blood flow, as well as the activation of inflammation, with important pathophysiological consequences.
METHODS/MATERIALS: Chart data relating to the procedures and perioperative conditions of the patients were collected on a standardized form. Comparisons of arterial lactate values at the end of the intraoperative period of the patients that presented, or not, with postoperative complications and frequencies related to perioperative conditions were established by odds ratio and nonparametric univariate analysis.
After surgeries without cardiopulmonary bypass (CPB), higher levels of arterial lactate upon ICU admission were observed in patients who had renal complications (2.96 vs 1.31 mm) and those who died (2.93 vs 1.40 mm). For surgeries with CPB, the same association was observed for cardiovascular (2.90 mm × 2.06 mm), renal (3.34 vs 2.33 mm), respiratory (2.98 vs 2.12 mm) and hematological complications (2.99 vs 1.95 mm), and death (3.38 vs 2.40 mm).
Elevated intraoperative arterial lactate levels are associated with a higher morbidity and mortality in low- and medium-risk procedures, with or without CPB, in pediatric cardiac surgery.
关联心脏手术患儿术中动脉血乳酸水平与术后并发症的发生情况。
动脉血乳酸水平可指示低灌注状态，作为该人群发病率和死亡率的预后标志物。
小儿心脏手术的麻醉通常在生理状况严重异常的患者身上进行。术中，血容量、体温、血浆成分、组织血流会有显著变化，炎症也会被激活，产生重要的病理生理后果。
方法/材料：用标准化表格收集与患者手术及围手术期情况相关的图表数据。通过比值比和非参数单变量分析，比较出现或未出现术后并发症的患者术中末期动脉血乳酸值，以及与围手术期情况相关的频率。
在非体外循环（CPB）手术中，发生肾脏并发症的患者（2.96对1.31 mmol/L）和死亡患者（2.93对1.40 mmol/L）在入住重症监护病房（ICU）时动脉血乳酸水平较高。对于CPB手术，心血管并发症（2.90 mmol/L对2.06 mmol/L）、肾脏并发症（3.34对2.33 mmol/L）、呼吸并发症（2.98对2.12 mmol/L）、血液学并发症（2.99对1.95 mmol/L）以及死亡患者（3.38对2.40 mmol/L）也有同样的关联。
小儿心脏手术中，无论有无CPB，术中动脉血乳酸水平升高与中低风险手术的较高发病率和死亡率相关。
