非体外循环冠状动脉旁路移植术联合室壁瘤切除术术后血乳酸变化的临床意义

Clinical significance and the changes of serum lactate levels after off-pump coronary artery bypass grafting plus ventricular aneurysmectomy

目的探讨非体外循环冠状动脉旁路移植术(OPCABG)加室壁瘤切除术后患者血乳酸的变化及其与预后的关系。方法回顾性分析2012年4月至2013年10月我院55例行OPCABG加室壁瘤切除术患者的临床资料,男45例,女10例,平均年龄(58±7)岁。分别监测患者返回监护室、术后6、12、24 h 4个时间段的血乳酸变化,对比血乳酸的变化与患者早期预后的关系。结果本组死亡13例,存活42例。死亡组返回监护室时血乳酸为(5.33±1.41)mmol/L,之后逐渐上升,至术后12 h达峰值(12.80±2.76)mmol/L。存活组返回监护室时血乳酸为(3.68±3.49)mmol/L,之后逐渐上升,至术后12 h达峰值(6.09±3.09)mmol/L。死亡组术后12 h血乳酸值显著高于存活组;2组12 h后血乳酸值逐渐下降,至术后24 h死亡组血乳酸值仍显著高于存活组[(6.80±1.07)mmol/L vs.(2.90±1.02)mmol/L],差异均有统计学意义(P<0.05)。结论 OPCABG加室壁瘤切除术术后血乳酸值增高是预测术后死亡的有效指标。

Objective To study the changes of serum lactate levels after off-pump coronary artery bypass grafting（OPCABG） plus ventricular aneurysmectomy and its relationship with prognosis. Methods The clinical data of 55 patients after OPCABG plus ventricular aneurysmectomy were analyzed. Forty-five were male,10 were female.The mean age was（58±7） years old. Dynamic changes of serum lactate levels at 0 h（T1）, 6 h（T2）, 12 h（T3） and 24 h（T4） after surgery were recorded, and the relationship between lactate level and prognosis was evaluated. Results Patients were divided into two groups,the survival group（42 cases） and the death group（13 cases）. The lactate level rose gradually after ICU admission in both groups and peaked at T3. The lactate levels of the death group at T3 were the highest, up to（12.80 ±2.76）mmol/L, whereas it was（6.09±3.09）mmol/L of the survival group. The lactate level declined rapidly after T3 in the survival group and returned to（2.90±1.02）mmol/L at T4. There was significant difference between the two groups at T3 and T4（P〈0.05）. Conclusion The change of blood lactate levels after OPCABG plus ventricular aneurysmectomy is associated with prognosis. Continuous blood lactate rising is a predictor of postoperative death.