Fang Y H, Zhang Y J, Zhen X P, Liu G, Sun Y X, Han Yongxin
Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2023 Jan 10;103(2):125-131. doi: 10.3760/cma.j.cn112137-20220725-01614.
To investigate the incidence, risk factors, and outcomes of hyperlactatemia after pulmonary endarterectomy (PEA) under deep hypothermic circulatory arrest (DHCA). From December 2016 to January 2022, patients receiving PEA in China-Japan Friendship Hospital were enrolled in the study. Arterial blood samples were analyzed intraoperatively. Multivariate logistic regression analysis was performed to identify the predictors of intraoperative lactate elevation as well as major factors influencing the clinical outcome of the surgery. A total of 110 patients (69 males and 41 females) were enrolled, aged (50.6±12.8) years. Receiver operating characteristic curve yielded an optimal cut-off lactate level of 7 mmol/L for predicting major postoperative complications (re-operation, re-intubation, postoperative renal failure requiring renal replacement therapy, wound infection, stroke, atrial fibrillation, and perioperative extracorporeal membrane oxygenation usage within 48 hours after surgery). Thirty-nine patients (35.5%) had an intraoperative peak arterial lactate level of≥7 mmol/L. According to intraoperative peak arterial lactate level, the patients were divided into two groups (<7 mmol/L and≥7 mmol/L). There were no statistically significant differences in age, sex and body mass index between the two groups (all >0.05). Intraoperative peak lactate level was associated with prolonged mechanical ventilation time (0.262, 0.008) and intensive care unit length of stay (0.304, 0.002). Multivariate logistic regression analysis identified three key variables associated with lactate level≥7 mmol/L: DHCA duration (=1.186, 95%: 1.027-1.370, =0.020), nadir hematocrit (HCT) (=0.580, 95%: 0.341-0.988, =0.045) and preoperative pulmonary vascular resistance (PVR) (=1.096, 95%: 1.020-1.177, =0.012). Patients with lactate≥7 mmol/L carried a higher rate of major complications (=0.001). For patients with lactate≥7 mmol/L, 41.0% (16 out of 39 cases) had major complications, while for patients with lactate<7 mmol/L, only 14.1% (10 out of 71) had major complications. There was no statistically significant difference in mortality (8.5% vs 10.3%, =0.753) between patients with different lactate levels. Moreover, intraoperative peak lactate level was a predictor of postoperative combined morbidity (=1.625, 95%: 1.176-2.245, =0.003). High intraoperative lactate levels are associated with higher preoperative PVR, lower nadir HCT, and longer DHCA duration. Intraoperative lactate levels are independently associated with increased combined morbidity.
探讨在深低温停循环（DHCA）下行肺动脉内膜剥脱术（PEA）后高乳酸血症的发生率、危险因素及预后。2016年12月至2022年1月，在中国-日本友好医院接受PEA的患者被纳入本研究。术中对动脉血样本进行分析。进行多因素逻辑回归分析以确定术中乳酸升高的预测因素以及影响手术临床结局的主要因素。共纳入110例患者（男69例，女41例），年龄（50.6±12.8）岁。受试者工作特征曲线得出预测术后主要并发症（再次手术、再次插管、术后需要肾脏替代治疗的肾衰竭、伤口感染、中风、心房颤动以及术后48小时内使用体外膜肺氧合）的最佳乳酸水平截断值为7 mmol/L。39例患者（35.5%）术中动脉血乳酸峰值水平≥7 mmol/L。根据术中动脉血乳酸峰值水平，将患者分为两组（<7 mmol/L和≥7 mmol/L）。两组患者在年龄、性别和体重指数方面无统计学差异（均>0.05）。术中乳酸峰值水平与机械通气时间延长（0.262，0.008）和重症监护病房住院时间延长（0.304，0.002）相关。多因素逻辑回归分析确定了与乳酸水平≥7 mmol/L相关的三个关键变量：DHCA持续时间（=1.186，95%：1.027 - 1.370，=0.020）、最低血细胞比容（HCT）（=0.580，95%：0.341 - 0.988，=0.045）和术前肺血管阻力（PVR）（=1.096，95%：1.020 - 1.177，=0.012）。乳酸≥7 mmol/L的患者主要并发症发生率更高（=0.001）。对于乳酸≥7 mmol/L的患者，41.0%（39例中的16例）发生主要并发症，而对于乳酸<7 mmol/L的患者，只有14.1%（71例中的10例）发生主要并发症。不同乳酸水平患者的死亡率无统计学差异（8.5%对10.3%，=0.753）。此外，术中乳酸峰值水平是术后合并症的预测指标（=1.625，95%：1.176 - 2.245，=0.003）。术中高乳酸水平与术前高PVR、低最低HCT和更长的DHCA持续时间相关。术中乳酸水平与合并症增加独立相关。
