Biesenbach Peter, Ghanpur Rashmi, Mårtensson Johan, Crisman Marco, Lindstrom Steven, Hilton Andrew, Matalanis George, Bellomo Rinaldo
Austin Hospital, Melbourne, VIC, Australia.
Warringal Private Hospital, Melbourne, VIC, Australia.
Crit Care Resusc. 2017 Sep;19(3):274-279.
Severe hyperlactataemia in patients after cardiac surgery is associated with poor prognosis and implies possible splanchnic hypoperfusion. Peripheral venoarterial extracorporeal membrane oxygenation (splanchnic ECMO) may be more effective at reducing lactic acidosis for these patients.
To investigate whether splanchnic ECMO attenuates hyperlactataemia and liver enzyme release in these patients, despite them having a cardiac index > 2 L/min/m and a mixed venous oxygen saturation > 55%.
Retrospective matched case- control study of patients treated with splanchnic ECMO for hyperlactataemia. Seven patients who had had cardiac surgery were treated with splanchnic ECMO compared with seven matched control patients.
We observed a mean decrease in lactate levels from 9.9 mmol/L (SD, 2.9 mmol/L) to 1.4 mmol/L (SD, 0.6 mmol/L) in patients receiving 48 hours of splanchnic ECMO, compared with a mean of 10.4 mmol/L (SD, 2.8 mmol/L) to 4.4 mmol/L (SD, 5 mmol/L) during 48 hours in control patients (P < 0.0001). Normalisation of lactate levels (to < 2 mmol/L) was achieved within a mean of 16.3 hours (SD, 14.6 hours) with splanchnic ECMO, compared with 38.3 hours (SD, 23.8 hours) in the control group (P = 0.029). The median increase in alanine aminotransferase level with splanchnic ECMO was 68% (range, -84% to 2015%) compared with 158% (range: 0%-6024%) (not significant) in control patients.
In a selected cohort of patients who had had cardiac surgery with severe post-operative hyperlactataemia, despite an acceptable cardiac index and a mixed venous oxygen saturation, splanchnic ECMO appeared to reduce overall lactate levels and time to normalisation of lactataemia.
心脏手术后患者出现严重高乳酸血症与预后不良相关，提示可能存在内脏低灌注。对于这些患者，外周静脉 - 动脉体外膜肺氧合（内脏ECMO）可能在降低乳酸酸中毒方面更有效。
探讨内脏ECMO是否能减轻这些患者的高乳酸血症及肝酶释放，尽管他们的心指数>2 L/min/m²且混合静脉血氧饱和度>55%。
对接受内脏ECMO治疗高乳酸血症患者的回顾性匹配病例对照研究。7例接受心脏手术的患者接受了内脏ECMO治疗，并与7例匹配的对照患者进行比较。
接受48小时内脏ECMO治疗的患者，乳酸水平平均从9.9 mmol/L（标准差，2.9 mmol/L）降至1.4 mmol/L（标准差，0.6 mmol/L），而对照患者在48小时内乳酸水平平均从10.4 mmol/L（标准差，2.8 mmol/L）降至4.4 mmol/L（标准差，5 mmol/L）（P<0.0001）。内脏ECMO治疗后，乳酸水平平均在16.3小时（标准差，14.6小时）内恢复正常（至<2 mmol/L），而对照组为38.3小时（标准差，23.8小时）（P = 0.029）。接受内脏ECMO治疗的患者丙氨酸氨基转移酶水平中位数升高68%（范围，-84%至2015%），而对照患者为158%（范围：0% - 6024%）（无显著差异）。
在一组心脏手术后出现严重术后高乳酸血症的特定患者中，尽管心指数和混合静脉血氧饱和度可接受，但内脏ECMO似乎能降低总体乳酸水平及乳酸血症恢复正常的时间。
