体外循环后乳酸性酸中毒与多器官功能障碍综合征之间的关联。
Association between lactic acidosis and multiple organ dysfunction syndrome after cardiopulmonary bypass.
作者信息
Zheng Dan, Yu Guo-Liang, Zhou Yi-Ping, Zhang Qiao-Min, Wang Chun-Guo, Zhang Sheng
机构信息
Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China.
Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China.
出版信息
PeerJ. 2024 Jan 31;12:e16769. doi: 10.7717/peerj.16769. eCollection 2024.
BACKGROUND
The relationship between hyperlactatemia and prognosis after cardiopulmonary bypass (CPB) is controversial, and some studies ignore the presence of lactic acidosis in patients with severe hyperlactacemia. This study explored the association between lactic acidosis (LA) and the occurrence of multiple organ dysfunction syndrome (MODS) after cardiopulmonary bypass.
METHODS
This study was a analysis of patients who underwent cardiac surgery between February 2017 and August 2018 and participated in a prospective study at Taizhou Hospital. The data were collected at: ICU admission (H0), and 4, 8, 12, 24, and 48 h after admission. Blood lactate levels gradually increased after CPB, peaking at H8 and then gradually decreasing. The patients were grouped as LA, hyperlactatemia (HL), and normal control (NC) based on blood test results 8 h after ICU admission. Basic preoperative, perioperative, and postoperative conditions were compared between the three groups, as well as postoperative perfusion and oxygen metabolism indexes.
RESULTS
There were 22 (19%), 73 (64%), and 19 (17%) patients in the LA, HL, and NC groups, respectively. APACHE II (24h) and SOFA (24h) scores were the highest in the LA group ( < 0.05). ICU stay duration was the longest for the LA group (48.5 (42.5, 50) h), compared with the HL (27 (22, 48) h) and NC (27 (25, 46) h) groups ( = 0.012). The LA group had the highest incidence of MODS (36%), compared with the HL (14%) and NC (5%) groups ( = 0.015). In the LA group, the oxygen extraction ratio (OER) was lower (21.5 (17.05, 32.8)%) than in the HL (31.3 (24.8, 37.6)%) and the NC group (31.3 (29.0, 35.4) %) ( = 0.018). In the univariable analyses, patient age (OR = 1.054, 95% CI [1.003-1.109], = 0.038), the LA group ( the NC group, (OR = 10.286, 95% CI [1.148-92.185], = 0.037), and ΔPCO2 at H8 (OR = 1.197, 95% CI [1.022-1.401], = 0.025) were risk factor of MODS after CPB.
CONCLUSIONS
We speculated that there was correlation between lactic acidosis and MODS after CPB. In addition, LA should be monitored intensively after CPB.
背景
体外循环（CPB）后高乳酸血症与预后的关系存在争议，一些研究忽视了严重高乳酸血症患者中乳酸酸中毒的存在。本研究探讨了乳酸酸中毒（LA）与体外循环后多器官功能障碍综合征（MODS）发生之间的关联。
方法
本研究对2017年2月至2018年8月在台州医院接受心脏手术并参与一项前瞻性研究的患者进行了分析。数据在以下时间点收集：重症监护病房（ICU）入院时（H0）以及入院后4、8、12、24和48小时。体外循环后血乳酸水平逐渐升高，在H8时达到峰值，然后逐渐下降。根据ICU入院8小时后的血液检测结果，将患者分为LA组、高乳酸血症（HL）组和正常对照组（NC）。比较三组患者术前、围手术期和术后的基本情况，以及术后灌注和氧代谢指标。
结果
LA组、HL组和NC组分别有22例（19%）、73例（64%）和19例（17%）患者。LA组的急性生理与慢性健康状况评分系统II（APACHE II，24小时）和序贯器官衰竭评估（SOFA，24小时）评分最高（P<0.05）。LA组的ICU住院时间最长（48.5（42.5，50）小时），与HL组（27（22，48）小时）和NC组（27（25，46）小时）相比（P=0.012）。LA组的MODS发生率最高（36%），与HL组（14%）和NC组（5%）相比（P=0.015）。在LA组中，氧摄取率（OER）低于HL组（31.3（24.8，37.6）%）和NC组（31.3（29.0，35.4）%）（P=0.018）。在单因素分析中，患者年龄（OR = 1.054，95%可信区间[1.003 - 1.109]，P = 0.038）、LA组（与NC组相比，（OR = 10.286，95%可信区间[1.148 - 92.185]，P = 0.037））以及H8时的ΔPCO2（OR = 1.197，95%可信区间[1.022 - 1.401]，P = 0.025）是体外循环后MODS的危险因素。
结论
我们推测体外循环后乳酸酸中毒与MODS之间存在相关性。此外，体外循环后应密切监测LA。
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