接受先天性心脏手术的儿科患者血清乳酸水平与预后的相关性。
Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery.
作者信息
Şahutoğlu Cengiz, Yaşar Ahmet, Kocabaş Seden, Aşkar Fatma Zekiye, Ayık Mehmet Fatih, Atay Yüksel
机构信息
Department of Anesthesiology and Reanimation, Medicine Faculty of Ege University, İzmir, Turkey.
Department of Cardiovascular Surgery, Medicine Faculty of Ege University, İzmir, Turkey.
出版信息
Turk Gogus Kalp Damar Cerrahisi Derg. 2018 Jul 3;26(3):375-385. doi: 10.5606/tgkdc.dergisi.2018.15791. eCollection 2018 Jul.
BACKGROUND
This study aimed to investigate the correlation between perioperative arterial lactate levels and morbidity and mortality in children undergoing cardiac surgery.
METHODS
A total of 236 patients who underwent open heart surgery due to congenital heart disease (121 males, 115 females; mean age 56.4 month (median: 42 month): range, 1 day to 204 month) between June 2014 and May 2016 were retrospectively analyzed. The arterial blood gas analysis results at baseline (after insertion of arterial cannula), during the cooling and warming-up phases in cardiopulmonary bypass, during the sternal closure, and at 0, 6, 12, and 24 hours in the postoperative intensive care unit stay were recorded. The patients were divided into two groups according to their lactate levels: Group 1 (lactate level <4.5 mmol/L, n=183) and Group 2 (lactate level ≥4.5 mmol/L, n=53). Correlation between the lactate groups and demographic data, intraoperative and postoperative variables, postoperative complications, and mortality were investigated.
RESULTS
Sixty-nine patients (29.2%) had cyanotic heart disease. A total of 53 patients (22.5%) had lactate levels of ≥4.5 mmol/L. At least one complication occurred in 41% of the patients. Development of at least one complication (p=0.027) and mortality rate (p<0.001) were significantly higher in the patients with lactate levels of ≥4.5 mmol/L. Seventeen patients (7.2%) died in the postoperative period, and 15 of them had lactate levels of ≥4.5 mmol/L at least once within the first 24 hours. In terms of mortality, lactate levels of ≥4.5 mmol/L at any time, prolonged mechanical ventilation (>48 hours), and undergoing complex surgery (high the Risk-adjusted Classification for Congenital Heart Surgery-1 score, category 4-6) were the independent risk factors for mortality.
CONCLUSION
Blood arterial lactate level of ≥4.5 mmol/L was found to be a risk factor for postoperative morbidity and mortality in pediatric patients undergoing congenital heart surgery.
背景
本研究旨在调查接受心脏手术的儿童围手术期动脉血乳酸水平与发病率和死亡率之间的相关性。
方法
回顾性分析2014年6月至2016年5月期间因先天性心脏病接受心脏直视手术的236例患者（男121例，女115例；平均年龄56.4个月（中位数：42个月）：范围，1天至204个月）。记录基线（动脉插管后）、体外循环降温及复温阶段、胸骨关闭时以及术后重症监护病房停留0、6、12和24小时时的动脉血气分析结果。根据乳酸水平将患者分为两组：第1组（乳酸水平<4.5 mmol/L，n = 183）和第2组（乳酸水平≥4.5 mmol/L，n = 53）。研究乳酸组与人口统计学数据、术中及术后变量、术后并发症和死亡率之间的相关性。
结果
69例患者（29.2%）患有青紫型心脏病。共有53例患者（22.5%）乳酸水平≥4.5 mmol/L。41%的患者发生了至少一种并发症。乳酸水平≥4.5 mmol/L的患者发生至少一种并发症的发生率（p = 0.027）和死亡率（p<0.001）显著更高。17例患者（7.2%）在术后死亡，其中15例在术后24小时内至少有一次乳酸水平≥4.5 mmol/L。在死亡率方面，任何时间乳酸水平≥4.5 mmol/L、机械通气时间延长（>48小时）以及接受复杂手术（先天性心脏病手术风险调整分类-1评分高，4-6类）是死亡的独立危险因素。
结论
发现动脉血乳酸水平≥4.5 mmol/L是接受先天性心脏病手术的儿科患者术后发病和死亡的危险因素。
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