Yang Hsiao-Hui, Chang Jui-Chih, Jhan Jin-You, Cheng Yi-Tso, Huang Yen-Ta, Chang Bee-Song, Chao Shen-Feng
Division of Cardiovascular Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2020 Feb 27;32(4):386-391. doi: 10.4103/tcmj.tcmj_215_19. eCollection 2020 Oct-Dec.
Tissue hypoperfusion during cardiopulmonary bypass (CPB) affects cardiac surgical outcomes. Lactate, an end product of anaerobic glycolysis from oxygen deficit, is a marker of tissue hypoxia. In this study, we aimed to identify the prognostic value of blood lactate level during CPB in predicting outcomes in adults undergoing cardiac surgeries.
We retrospectively reviewed the medical records of patients who underwent cardiac surgeries with CPB from January 2015 to December 2015. Data about the characteristics of patients, preoperative status, type of surgery, and intraoperative lactate levels were collected. The outcomes were in-hospital mortality and complications. The receiver operating characteristics (ROC) curves were used to assess the ability of peak lactate level during CPB in predicting in-hospital mortality.
A total of 97 patients, including 61 who underwent emergent or urgent surgery, were enrolled. The types of surgery included coronary artery bypass grafting (CABG, = 52), valve surgery ( = 27), combined surgery (CABG and valve surgery, = 4), great vessel surgery (including aortic dissection, = 9), and others ( = 5). The median CPB time was 139 min (interquartile range = 120-175). The median initial lactate and peak lactate levels during CPB were 0.9 and 4.2 mmol/L, respectively. In-hospital mortality was 14.4%, which was significantly associated with age and peak lactate level in the multivariate logistic regression model. When the peak lactate level during CPB reached 7.25 mmol/L, in-hospital mortality could be predicted with an area under the ROC curve of 0.75 (95% confidence interval: 0.59-0.90; = 0.003), with a sensitivity of 57% and specificity of 93%.
Hyperlactatemia during CPB was associated with increased in-hospital mortality. Thus, early detection of such conditions and aggressive postoperative care are important.
体外循环（CPB）期间的组织灌注不足会影响心脏手术的结果。乳酸是缺氧时无氧糖酵解的终产物，是组织缺氧的标志物。在本研究中，我们旨在确定CPB期间血乳酸水平在预测接受心脏手术的成人患者结局方面的预后价值。
我们回顾性分析了2015年1月至2015年12月期间接受CPB心脏手术患者的病历。收集了患者特征、术前状态、手术类型和术中乳酸水平的数据。结局指标为住院死亡率和并发症。采用受试者工作特征（ROC）曲线评估CPB期间乳酸峰值水平预测住院死亡率的能力。
共纳入97例患者，其中61例接受急诊或紧急手术。手术类型包括冠状动脉旁路移植术（CABG，n = 52）、瓣膜手术（n = 27）、联合手术（CABG和瓣膜手术，n = 4）、大血管手术（包括主动脉夹层，n = 9）和其他手术（n = 5）。CPB的中位时间为139分钟（四分位间距 = 120 - 175）。CPB期间乳酸初始值和峰值的中位数分别为0.9和4.2 mmol/L。住院死亡率为14.4%，在多因素逻辑回归模型中，这与年龄和乳酸峰值水平显著相关。当CPB期间乳酸峰值水平达到7.25 mmol/L时，预测住院死亡率的ROC曲线下面积为0.75（95%置信区间：0.59 - 0.90；P = 0.003），敏感性为57%，特异性为93%。
CPB期间高乳酸血症与住院死亡率增加相关。因此，早期发现此类情况并积极进行术后护理很重要。
