Department of Basic Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
Department of Cardiac Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Iran J Med Sci. 2024 Sep 1;49(9):550-558. doi: 10.30476/ijms.2023.99730.3186. eCollection 2024 Sep.
Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) is utilized to minimize hemodilution. However, removing high volumes leads to tissue hypoperfusion by activating the anaerobic glycolysis pathways. This study aimed to determine the association between weight-indexed CUF volumes and lactate in patients who underwent coronary artery bypass grafting (CABG).
In this single-center retrospective study, 641 CABG patients, who were referred to Al-Zahra Hospital (Shiraz, Iran) and underwent CPB, during 2019-2021, were recruited. Peri-operative parameters were extracted from the patient's records. The patients with non-elective status, pre-existing liver and renal diseases, ejection fraction<35%, and repeated sternotomy were excluded from the study. An increase in post-operative lactate level≥4 mmol/L after 6 hours was defined as hyperlactatemia (HL). To predict HL, univariable and multiple logistic regression modeling, while controlling confounding factors, were employed.
The patients' mean age was 58.8±11.1 years, and 39.2% were women. The incidence of HL was 14.5% (93 patients). There was a significant association between weight-indexed CUF volume and HL. The volume removed in the HL patients was almost doubled (43.37±11.32 21.41±8.15 mL/Kg, P<0.001), and the higher the weight-indexed CUF volume, the more likely to develop an HL at a rate of 1.38 (Odds ratio=1.38 [1.27-1.49], 95% CI, P<0.001). Furthermore, the multiple logistic regression model showed that HL was associated with the lowest mean arterial pressure (MAP) during CPB.
A higher volume of ultrafiltration was associated with increased post-operative serum lactate levels.
体外循环（CPB）期间常规使用超滤（CUF）以尽量减少血液稀释。然而，去除大量液体通过激活无氧糖酵解途径导致组织灌注不足。本研究旨在确定接受冠状动脉旁路移植术（CABG）的患者体重指数超滤量与乳酸之间的关系。
这是一项单中心回顾性研究，纳入了 2019 年至 2021 年期间在伊朗设拉子的 Al-Zahra 医院接受 CPB 的 641 例 CABG 患者。从患者记录中提取围手术期参数。排除非选择性状态、既往肝肾功能不全、射血分数<35%和再次开胸的患者。术后 6 小时后血乳酸水平升高≥4mmol/L 定义为高乳酸血症（HL）。采用单变量和多变量逻辑回归模型，在控制混杂因素的情况下，预测 HL。
患者的平均年龄为 58.8±11.1 岁，39.2%为女性。HL 的发生率为 14.5%（93 例）。体重指数超滤量与 HL 之间存在显著相关性。HL 患者去除的容量几乎增加了一倍（43.37±11.32 vs. 21.41±8.15 mL/Kg，P<0.001），体重指数超滤量越高，HL 的发生率越高，为 1.38（优势比=1.38 [1.27-1.49]，95%CI，P<0.001）。此外，多变量逻辑回归模型显示，HL 与 CPB 期间最低平均动脉压（MAP）相关。
超滤量较高与术后血清乳酸水平升高相关。
