Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio; Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
Ann Thorac Surg. 2020 Aug;110(2):434-440. doi: 10.1016/j.athoracsur.2020.02.046. Epub 2020 Mar 26.
Elevated lactate levels may be caused by increased production suggestive of tissue ischemia; however, they may also occur without evidence of ischemia, by catecholamine activation of beta receptors. The purpose of this study was to determine the factors associated with increased lactate levels during and after lung transplantation and to evaluate whether lactate levels were associated with increased time to extubation and postoperative complications.
This was a retrospective study of patients who underwent lung transplantation between January 2015 and May 2017 at the University of Michigan, Ann Arbor, MI. Multivariable linear regression was used to determine the factors associated with peak lactate levels and to find the associations between lactate levels and outcomes of nitric oxide time, intubation time, length of stay, and creatinine level. Logistic regression was used to determine the associations between lactate levels and acute kidney injury and atrial fibrillation.
A total of 86 patients underwent single-lung transplantation (n = 17; 20%) or double-lung transplantation (n = 69; 80%). All patients initially had normal lactate levels. On univariate analysis, lactate levels at several time points were correlated with subsequent acute kidney injury, increased time to extubation, and increased nitric oxide time. After adjustment, the study found that higher peak intensive care unit lactate levels (regression coefficient B = 0.046; interquartile range, 0.006, 0.086; P = .025) were associated with longer length of stay.
Cardiopulmonary bypass time, total ischemic time, and catecholamine use were associated with higher lactate levels, whereas nitric oxide and higher pulmonary artery pressures were associated with lower levels. Increased lactate levels were independently associated with longer intubation times, postoperative acute kidney injury, and longer length of stay.
乳酸水平升高可能是由于组织缺血引起的产生增加所致；然而，在没有缺血证据的情况下，儿茶酚胺也会通过激活β受体而导致乳酸水平升高。本研究旨在确定与肺移植期间和之后乳酸水平升高相关的因素，并评估乳酸水平是否与拔管时间延长和术后并发症有关。
这是一项回顾性研究，纳入了 2015 年 1 月至 2017 年 5 月在密歇根大学安娜堡分校接受肺移植的患者。采用多变量线性回归确定与峰值乳酸水平相关的因素，并探讨乳酸水平与一氧化氮时间、插管时间、住院时间和肌酐水平等结果之间的关系。采用逻辑回归确定乳酸水平与急性肾损伤和心房颤动之间的关系。
共有 86 例患者接受了单肺移植（n=17；20%）或双肺移植（n=69；80%）。所有患者初始乳酸水平正常。单变量分析发现，几个时间点的乳酸水平与随后的急性肾损伤、拔管时间延长和一氧化氮时间延长有关。调整后，研究发现，更高的 ICU 峰值乳酸水平（回归系数 B=0.046；四分位距，0.006，0.086；P=0.025）与住院时间延长有关。
体外循环时间、总缺血时间和儿茶酚胺的使用与乳酸水平升高有关，而一氧化氮和肺动脉压升高与乳酸水平降低有关。乳酸水平升高与插管时间延长、术后急性肾损伤和住院时间延长独立相关。
