Siegel L B, Dalton H J, Hertzog J H, Hopkins R A, Hannan R L, Hauser G J
Division of Pediatric Critical Care, Mount Sinai Medical Center, New York, NY 10029, USA.
Intensive Care Med. 1996 Dec;22(12):1418-23. doi: 10.1007/BF01709563.
To evaluate the relationship between postoperative serum lactate levels and outcome in children undergoing open heart surgery.
Prospective, noninterventional study.
Pediatric intensive care unit (PICU) of a university hospital.
41 nonconsecutive children who had had cardiopulmonary bypass for repair of congenital heart disease.
None.
Serum lactate levels were measured on admission to the PICU immediately after open heart surgery. Lactate levels were correlated with bypass and cross clamp times, estimated intraoperative blood loss, lowest temperature on bypass, admission Pediatric Risk of Mortality score, anion gap, and measures of postoperative morbidity. Mean lactate levels on admission to the PICU were 6.86 +/- 0.79 mmol/l for nonsurvivors (n = 7) and 2.38 +/- 0.13 mmol/l for survivors (n = 34) (p < 0.0001), and 4.87 +/- 0.7 mmol/l and 2.35 +/- 0.19 mmol/l, for patients with (n = 11) and without (n = 30) multiple organ system failure, respectively (p < 0.0001). Admission lactate levels correlated with all measurements of postoperative morbidity. A serum lactate level of greater than 4.2 mmol/l had a positive predictive value of 100% and a negative predictive value of 97% for postoperative death.
Initial postoperative serum lactate levels after pediatric open heart surgery may be predictive of outcome. Lactate levels are also higher in patients who go on to develop multiple organ system failure. Elevated postoperative lactate levels may reflect intraoperative tissue hypoperfusion, and measures aimed at increasing oxygen delivery, with normalization of lactate, may improve patient outcome.
评估接受心脏直视手术的儿童术后血清乳酸水平与预后的关系。
前瞻性、非干预性研究。
大学医院的儿科重症监护病房（PICU）。
41例非连续性接受先天性心脏病修复体外循环手术的儿童。
无。
在心脏直视手术后患儿进入PICU时即刻测量血清乳酸水平。乳酸水平与体外循环和主动脉阻断时间、估计术中失血量、体外循环最低温度、入院时儿童死亡风险评分、阴离子间隙以及术后发病率指标相关。进入PICU时，非存活者（n = 7）的平均乳酸水平为6.86±0.79 mmol/L，存活者（n = 34）为2.38±0.13 mmol/L（p < 0.0001）；发生多器官系统功能衰竭的患者（n = 11）和未发生多器官系统功能衰竭的患者（n = 30）分别为4.87±0.7 mmol/L和2.35±0.19 mmol/L（p < 0.0001）。入院时乳酸水平与所有术后发病率指标相关。血清乳酸水平大于4.2 mmol/L对术后死亡的阳性预测值为100%，阴性预测值为97%。
小儿心脏直视手术后早期血清乳酸水平可能可预测预后。发生多器官系统功能衰竭的患者乳酸水平也更高。术后乳酸水平升高可能反映术中组织灌注不足，旨在增加氧输送并使乳酸水平正常化的措施可能改善患者预后。
