Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China.
Department of Cardiopulmonary Bypass, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
BMC Anesthesiol. 2021 Dec 8;21(1):309. doi: 10.1186/s12871-021-01537-w.
Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery.
Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year.
Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group.
Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery.
This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 8/1/2020 with the registration number ChiCTR2000028941 . It was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in Shanghai Chest Hospital.
高乳酸血症与心脏手术患者的预后不良相关。本研究探讨了体外循环（CPB）期间目标血压管理对心脏手术后血乳酸水平的影响。
2020 年 1 月 20 日至 6 月 30 日期间在上海胸科医院接受心脏瓣膜手术的成年患者被纳入研究。患者被随机分为低平均动脉压（L-MAP）组（目标 MAP 为 50-60mmHg）或高平均动脉压（H-MAP）组（目标 MAP 为 70-80mmHg），每组 20 例。仅在 CPB 期间滴定去甲肾上腺素以维持 MAP 在目标水平。两组患者在术前（T0）、CPB 结束时（T1）、手术结束时（T2）、术后 1 小时（T3）、术后 6 小时（T4）和术后 24 小时（T5）检测血乳酸水平。主要结局为手术结束时（T2）的血乳酸水平。次要结局包括 T1、T3、T4 和 T5 时的血乳酸水平以及术后 24 小时内肾上腺素和多巴胺的剂量、拔管时间、ICU 住院时间、术后 30 天内再入院率和 1 年内死亡率。
本研究共纳入 40 例患者进行分析。H-MAP 组在手术结束时（3.1[IQR 2.1，5.0]比 2.1[IQR 1.7，2.9]，P=0.008）和 CPB 结束时及术后 1 小时的血乳酸水平明显低于 L-MAP 组。术后 24 小时内肾上腺素剂量、拔管时间和 ICU 住院时间在 L-MAP 组明显高于 H-MAP 组。
CPB 期间维持相对较高的 MAP 可降低手术结束时的血乳酸水平，减少肾上腺素的消耗，并缩短术后拔管时间和 ICU 住院时间。
本单中心、前瞻性、RCT 于 2020 年 8 月 1 日在中国临床试验中心完成注册，注册号 ChiCTR2000028941。它于 2020 年 1 月 20 日至 6 月 30 日在上海胸科医院进行，作为一项单一、盲法试验。
