血清乳酸水平是心脏刺伤死亡率的独立预测指标——南非的经验。
Serum lactate level is an independent predictor of mortality in cardiac stab wounds - A South African experience.
作者信息
Kong Victor, Ko Jonathan, Narayanan Anantha, Hassan Summer, Leow Priscilla, Lim Jia, Bruce John, Laing Grant, Clarke Damian
机构信息
Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
Department of Surgery, University of KwaZulu Natal, Durban, South Africa.
出版信息
Surg Pract Sci. 2023 Feb 6;12:100157. doi: 10.1016/j.sipas.2023.100157. eCollection 2023 Mar.
INTRODUCTION
Despite dramatic advances in the care of trauma patients over the last fifty years, cardiac stab wounds (CSW) remain highly lethal, and the specific relationship between serum lactate level and mortality is unknown.
METHODS
A retrospective review was conducted on all patients who presented with intraoperatively confirmed CSW from January 2008 to January 2020 at a major trauma centre in South Africa. Admission serum lactate level and patients' clinical outcomes were reviewed.
RESULTS
During the 12-year study period, a total of 236 patients were included (84% male, mean age: 28 years). Mean value of admission physiology: Systolic Blood Pressure: 79 mmHg, pH: 7.2, Serum Lactate: 6 mmol/l. Surgical access was via: median sternotomy in 65% (153/236) and the remaining 35% (83/236) via lateral thoracotomy. In 92% (217/236), there was a single cardiac chamber injury; in the remaining 8% (19/236), multiple cardiac chambers were injured. The overall mortality was 18% (43/236). Lactate was a significant predictor of mortality (AUC 93.8, <0.001). Using a cut-off point of ≥ 7.4 mmol/l, the sensitivity was 93%, and the specificity was 91% in predicting mortality. A lactate ≥ 7.4 mmol/l was associated with 242 times higher odds of mortality (95% CI 38 - 1551).
CONCLUSION
CSWs remain highly lethal, and an initial serum lactate level ≥ 7.4 mmol/l is associated with increased mortality.
引言
尽管在过去五十年中创伤患者的护理取得了巨大进展，但心脏刺伤（CSW）仍然具有很高的致死率，血清乳酸水平与死亡率之间的具体关系尚不清楚。
方法
对2008年1月至2020年1月在南非一家主要创伤中心接受术中确诊为CSW的所有患者进行回顾性研究。回顾了入院时的血清乳酸水平和患者的临床结局。
结果
在为期12年的研究期间，共纳入236例患者（84%为男性，平均年龄：28岁）。入院时生理指标的平均值：收缩压：79mmHg，pH值：7.2，血清乳酸：6mmol/L。手术入路方式为：65%（153/236）采用正中胸骨切开术，其余35%（83/236）采用侧胸壁切开术。92%（217/236）的患者有单个心腔损伤；其余8%（19/236）的患者有多个心腔损伤。总体死亡率为18%（43/236）。乳酸是死亡率的显著预测指标（AUC 93.8，<0.001）。以≥7.4mmol/L为临界值，预测死亡率的敏感性为93%，特异性为91%。乳酸≥7.4mmol/L与死亡几率高242倍相关（95%CI 38 - 1551）。
结论
心脏刺伤仍然具有很高的致死率，初始血清乳酸水平≥7.4mmol/L与死亡率增加相关。
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