非心脏手术后术中高乳酸血症与心肌损伤之间的关联。

Association between Intraoperative Hyperlactatemia and Myocardial Injury after Noncardiac Surgery.

作者信息

Kim Jeayoun, Park Jungchan, Kwon Ji-Hye, Kim Sojin, Oh Ah Ran, Jang Jae Ni, Choi Jin-Ho, Sung Jidong, Yang Kwangmo, Kim Kyunga, Ahn Joonghyun, Lee Seung-Hwa

机构信息

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

Department of Medicine, Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

出版信息

Diagnostics (Basel). 2021 Sep 9;11(9):1656. doi: 10.3390/diagnostics11091656.

DOI:10.3390/diagnostics11091656

PMID:34573997

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8465750/

Abstract

BACKGROUND

Oxygen demand-supply mismatch is supposed to be one of the major causes of myocardial injuries after noncardiac surgery (MINS). Impaired tissue oxygenation during the surgery can lead to intraoperative hyperlactatemia. Therefore, we aimed to evaluate the relationship between intraoperative lactate level and MINS.

METHODS

A total of 1905 patients divided into groups according to intraoperative hyperlactatemia: 1444 patients (75.8%) into normal (≤2.2 mmol/L) and 461 patients (24.2%) into hyperlactatemia (>2.2 mmol/L) groups. The primary outcome was the incidence of MINS, and all-cause mortality within 30 days was compared.

RESULTS

In the crude population, the risks for MINS and 30-day mortality were higher for the hyperlactatemia group than the normal group (17.7% vs. 37.7%, odds ratio [OR]: 2.83, 95% confidence interval [CI]: 2.24-3.56, < 0.001 and 0.8% vs. 4.8%, hazard ratio [HR]: 5.86, 95% CI: 2.9-12.84, < 0.001, respectively). In 365 propensity score-matched pairs, intraoperative hyperlactatemia was consistently associated with MINS and 30-day mortality (21.6% vs. 31.8%, OR: 1.69, 95% CI: 1.21-1.36, = 0.002 and 1.1% vs. 3.8%, HR: 3.55, 95% CI: 1.71-10.79, < 0.03, respectively).

CONCLUSION

Intraoperative lactate elevation was associated with a higher incidence of MINS and 30-day mortality.

摘要

背景

氧供需不匹配被认为是非心脏手术（MINS）后心肌损伤的主要原因之一。手术期间组织氧合受损可导致术中高乳酸血症。因此，我们旨在评估术中乳酸水平与MINS之间的关系。

方法

根据术中高乳酸血症将1905例患者分组：1444例患者（75.8%）为正常（≤2.2 mmol/L）组，461例患者（24.2%）为高乳酸血症（>2.2 mmol/L）组。主要结局是MINS的发生率，并比较30天内的全因死亡率。

结果

在总体人群中，高乳酸血症组的MINS风险和30天死亡率高于正常组（17.7%对37.7%，比值比[OR]：2.83，95%置信区间[CI]：2.24 - 3.56，P < 0.001；0.8%对4.8%，风险比[HR]：5.86，95% CI：2.9 - 12.84，P < 0.001）。在365对倾向评分匹配的配对中，术中高乳酸血症与MINS和30天死亡率始终相关（21.6%对31.8%，OR：1.69，95% CI：1.21 - 1.36，P = 0.002；1.1%对3.8%，HR：3.55，95% CI：1.71 - 10.79，P < 0.03）。