Department of Cardiothoracic Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY; Department of Anesthesiology, The Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Anesthesiology, The Icahn School of Medicine at Mount Sinai, New York, NY; Department of Genomics and Genetics Sciences, The Icahn School of Medicine at Mount Sinai, New York, NY.
J Cardiothorac Vasc Anesth. 2018 Apr;32(2):636-643. doi: 10.1053/j.jvca.2017.08.002. Epub 2017 Aug 2.
Blood lactate is frequently used to guide management in critically ill patients. In patients undergoing mitral valve surgery, an elevated lactate level is frequently observed; however, overall mortality is low. The authors hypothesized that hyperlactemia is not a useful predictor of poor outcomes in this patient population. The main aim of this study was to explore how blood lactate level and lactate clearance are associated with 30-day mortality and major adverse events in patients undergoing mitral valve surgery.
This was a retrospective database review. Logistic regression analysis was performed to assess the associations of perioperative factors with blood lactate in the intensive care unit (ICU).
Tertiary-care teaching hospital.
The study comprised 917 patients undergoing mitral valve surgery.
None.
The majority of patients (71.8%) had elevated blood lactate ≥2 mmol/L on ICU admission; however, within 24 hours, 85.1% of all patients had normal lactate values. Overall 30-day mortality was 2.29% (n = 21). The combination of lactate ≥7 mmol/L on ICU admission and a persistent elevated blood lactate level 24 hours after ICU admission provides an excellent prediction of 30-day mortality (C statistic = 0.85). However, even a significantly elevated lactate level on ICU admission was well-tolerated in the majority of patients as long as lactate values normalized within 24 hours. Male sex, longer cardiopulmonary bypass time, blood transfusion in the ICU, and an elevated blood lactate level on ICU admission and 12 hours after ICU admission all were independent risk factors of clearance failure.
An elevated blood lactate level is common after mitral valve surgery and is well-tolerated in the majority of patients. Adding lactate clearance improved the predictive value of the blood lactate level.
血乳酸常被用于指导危重症患者的治疗。在行二尖瓣手术的患者中，常观察到乳酸水平升高；但总体死亡率较低。作者假设，在该患者人群中，高乳酸血症不是预后不良的有用预测指标。本研究的主要目的是探讨血乳酸水平和乳酸清除率与行二尖瓣手术患者的 30 天死亡率和主要不良事件的关系。
这是一项回顾性数据库研究。采用逻辑回归分析评估围术期因素与 ICU 中血乳酸的关系。
三级教学医院。
本研究纳入 917 例行二尖瓣手术的患者。
无。
大多数患者（71.8%）在入 ICU 时血乳酸升高≥2mmol/L；然而，在 24 小时内，所有患者中 85.1%的血乳酸值恢复正常。总体 30 天死亡率为 2.29%（n=21）。ICU 入院时血乳酸≥7mmol/L且 ICU 入院 24 小时后血乳酸持续升高的联合情况可极好地预测 30 天死亡率（C 统计量=0.85）。然而，只要在 24 小时内乳酸值恢复正常，大多数患者的 ICU 入院时的高乳酸血症仍可耐受。男性、体外循环时间较长、ICU 输血和 ICU 入院及 12 小时后血乳酸水平升高均是清除失败的独立危险因素。
在行二尖瓣手术后，血乳酸水平升高很常见，且大多数患者可耐受。增加乳酸清除率可提高血乳酸水平的预测价值。
