Unidad de Cuidados Intensivos Cardiovasculares, Instituto Nacional de Pediatría, Mexico City.
Kardias A.C.
Bol Med Hosp Infant Mex. 2023;80(4):253-259. doi: 10.24875/BMHIM.23000066.
In congenital heart surgery, low cardiac output syndrome (LCOS) is a major cause of morbidity in the immediate post-operative period. A decrease in cardiac output leads to an increase in tissue oxygen consumption. Several biomarkers such as venous oxygen saturation (SvO), arteriovenous oxygen difference (DavO), and lactate can assess tissue perfusion in the presence of LCOS. Recently, central venous to arterial CO difference (ΔCO) has been proposed as a biomarker of tissue ischemia that could be used as a predictor of death in neonatal patients. This study aimed to analyze the relationship between ΔCO and immediate post-operative outcomes in pediatric patients undergoing congenital heart surgery and its correlation with DavO, SvO, and lactate.
We conducted a longitudinal study of patients aged 0-18 years who underwent congenital heart surgery with or without cardiopulmonary bypass at the Instituto Nacional de Pediatría, from March 2019 to March 2021.
Eighty-two patients were included; the median age was 17 months. About 59% had a ΔCO ≥ 6 mmHg. Patients with ΔCO ≥ 6 mmHg had a vasoactive-inotropic score > 5 (p < 0.001), DavO > 5 mL/dL (p = 0.048), and lactate > 2 mmol/L (p = 0.027), as well as a longer hospital stay (p = 0.043). Patients with ΔCO > 6 mmHg and vasoactive-inotropic score ≥ 10 were 12.6 times more likely to die.
ΔCO is a good marker of tissue hypoperfusion and outcome in the post-operative period of congenital heart surgery.
在先天性心脏病手术中，低心输出量综合征（LCOS）是术后早期发病率的主要原因。心输出量的减少会导致组织耗氧量增加。一些生物标志物，如静脉血氧饱和度（SvO）、动静脉氧差（DavO）和乳酸，可在存在 LCOS 时评估组织灌注。最近，中心静脉至动脉 CO 差（ΔCO）已被提出作为组织缺血的生物标志物，可作为新生儿患者死亡的预测指标。本研究旨在分析接受先天性心脏病手术的儿科患者中ΔCO 与术后即刻结局之间的关系及其与 DavO、SvO 和乳酸的相关性。
我们对 2019 年 3 月至 2021 年 3 月在墨西哥国立儿科研究所接受体外循环或不接受体外循环的先天性心脏病手术的 0-18 岁患者进行了一项纵向研究。
共纳入 82 例患者，中位年龄为 17 个月。约 59%的患者ΔCO≥6mmHg。ΔCO≥6mmHg 的患者血管活性-正性肌力评分>5（p<0.001），DavO>5mL/dL（p=0.048），乳酸>2mmol/L（p=0.027），住院时间更长（p=0.043）。ΔCO>6mmHg 和血管活性-正性肌力评分≥10 的患者死亡的可能性增加 12.6 倍。
ΔCO 是先天性心脏病手术后组织低灌注和结局的良好标志物。
