Naik Rakesh, George Gladdy, Karuppiah Sathappan, Philip Madhu Andrew
Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Ann Card Anaesth. 2016 Oct-Dec;19(4):668-675. doi: 10.4103/0971-9784.191579.
To identify the factors causing high lactate levels in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) and to assess the association between high blood lactate levels and postoperative morbidity and mortality.
A retrospective observational study including 370 patients who underwent cardiac surgeries under cardiopulmonary bypass. The patients were divided into 2 groups based on serum lactate levels; those with serum lactate levels greater than or equal to 4 mmol/L considered as hyperlactatemia and those with serum lactate levels less than 4 mmol/L. Blood lactate samples were collected intraoperatively and postoperatively in the ICU. Preoperative and intraoperative risk factors for hyperlactatemia were identified using the highest intraoperative value of lactate. The postoperative morbidity and mortality associated with hyperlactatemia was studied using the overall (intraoperative and postoperative values) peak lactate levels. Preoperative clinical data, perioperative events and postoperative morbidity and mortality were recorded.
Intraoperative peak blood lactate levels of 4.0 mmol/L or more were present in 158 patients (42.7%). Females had higher peak intra operative lactate levels (P = 0.011). There was significant correlation between CPB time (Pearson correlation coefficient r = 0.024; P = 0.003) and aortic cross clamp time (r = 0.02, P = 0.007) with peak intraoperative blood lactate levels. Patients with hyperlactatemia had significantly higher rate of postoperative morbidity like atrial fibrillation (19.9% vs. 5.3%; P = 0.004), prolonged requirement of inotropes (34% vs. 11.8%; P = 0.001), longer stay in the ICU (P = 0.013) and hospital (P = 0.001).
Hyperlactatemia had significant association with post-operative morbidity. Detection of hyperlactatemia in the perioperative period should be considered as an indicator of inadequate tissue oxygen delivery and must be aggressively corrected.
确定在体外循环（CPB）下接受心脏手术患者中导致高乳酸水平的因素，并评估高血乳酸水平与术后发病率和死亡率之间的关联。
一项回顾性观察性研究，纳入370例在体外循环下接受心脏手术的患者。根据血清乳酸水平将患者分为两组；血清乳酸水平大于或等于4 mmol/L者被视为高乳酸血症，血清乳酸水平低于4 mmol/L者为另一组。在术中及术后重症监护病房（ICU）采集血乳酸样本。使用术中乳酸的最高值确定高乳酸血症的术前和术中危险因素。使用总体（术中及术后值）峰值乳酸水平研究与高乳酸血症相关的术后发病率和死亡率。记录术前临床数据、围手术期事件以及术后发病率和死亡率。
158例患者（42.7%）术中血乳酸峰值水平达到或超过4.0 mmol/L。女性术中乳酸峰值水平较高（P = 0.011）。体外循环时间（Pearson相关系数r = 0.024；P = 0.003）和主动脉阻断时间（r = 0.02，P = 0.007）与术中血乳酸峰值水平存在显著相关性。高乳酸血症患者术后房颤等发病率显著更高（19.9% 对5.3%；P = 0.004）、血管活性药物使用时间延长（34% 对11.8%；P = 0.001）、在ICU的停留时间更长（P = 0.013）以及住院时间更长（P = 0.001）。
高乳酸血症与术后发病率显著相关。围手术期检测到高乳酸血症应被视为组织氧输送不足的指标，必须积极纠正。
