体外循环心脏手术围术期相关因素与乳酸的关系

目的研究体外循环心脏手术围术期血乳酸水平与相关因素的关系。方法采用随机数字表法将404例体外循环心脏患者经手术后分为生存组(n=394)与死亡组(n=10),分别于转机前、转中阻断升主动脉后、停机时、术后24 h记录乳酸浓度,分析围术期血乳酸水平变化趋势与性别、年龄、阻断时间及生死预后的关系。结果术中体外循环停机时及术后24 h对应的死亡组乳酸值(3.65±0.49、3.93±0.49)明显高于存活组乳酸值(1.77±0.03、2.79±0.05)(P<0.05);≤14岁的患者在手术中阻断升主动脉后的乳酸水平(2.82±0.04)、体外循环停机时乳酸水平(3.10±0.05)、术后24 h乳酸水平(1.94±0.03)均高于年龄>14岁的患者各时点对应的乳酸水平(1.56±0.05、2.01±0.07、1.52±0.08)(P<0.05);升主动脉阻断时间大于120 min组停机时乳酸值(3.47±0.49)及术后24 h的乳酸值(3.24±0.75)明显高于其他3组,差异有统计学意义有意义(P<0.05);性别与乳酸水平无明显相关,统计学上无意义。结论动态血气分析反映乳酸水平及趋势及与相关因素的关系,为临床评估及判断提供依据。

Objective Relations bypass heart surgery perioperative blood lactate levels and related factors.Methods With a random number table monitoring 404 cases in our hospital patients after cardiopulmonary bypass surgery into survival group and death group, perioperative blood lactate levels, respectively, before turning, turn in blocking the ascending aorta, shutdown , lactate concentration after 24h record, analyze perioperative blood lactate levels and trends of their gender, age, blocking time and death prognosis.Results Survival group and lactate values at each time point of death group, the group of death in cardiopulmonary bypass surgery and 24h after the death of the corresponding lactate values （3.65 ± 0.49,3.93 ± 0.49） was signiifcantly higher than the survival group lactate values （1.77 ± 0.03,2.79 ± 0.05）, ≤14 years were blocked at each time point after aortic surgery in lactate levels （2.82 ± 0.04） during cardiopulmonary bypass lactate levels （3.10 ± 0.05） after 24h lactic levels （1.94 ± 0.03） were higher than those aged〉 14 years were at each time point corresponding lactate levels （1.56 ± 0.05,2.01 ± 0.07,1.52 ± 0.08）; aortic clamping time greater than 120min constituency down lactic acid value （3.47 ± 0.49） and postoperative lactate value 24h of （3.24 ± 0.75） was signiifcantly higher than that of aortic clamping time 120min constituency larger than the other three groups, statistically signiifcant compared （P 14 years were; gender and lactate levels were not significantly correlated , statistically insignificant Conclusion Dynamic lactate levels and blood gas analysis to reflect trends and relationships with related factors provide a basis for clinical assessment and judgment.