血乳酸浓度对急性A型主动脉夹层术后患者预后的影响

Effect of blood lactic acid concentration on prognosis of patients with acute A-type aortic dissection after surgery

目的回顾性研究血乳酸浓度测定在预测急性A型主动脉夹层术后患者预后的价值。方法对144例在深圳市孙逸仙心血管医院接受急性A型主动脉夹层手术,术后转入重症监护病房(intensive care unit,ICU)监护治疗的患者进行回顾性研究。收集这些患者复苏、入ICU初始及每2~6 h监测的血乳酸浓度,根据氧合指数和改善全球肾脏病预后组织(kidney disease:improving global outcomes,KDIGO)关于急性肾损伤的标准,患者被分为低氧血症组、非低氧血症组和急性肾损伤组、正常肾功能组。记录各组患者平均机械通气时间、ICU滞留时间及病死率,比较各组间乳酸和乳酸清除率的差别。并绘制受试者工作特征曲线(receiver operator characteristic curve,ROC)分析血乳酸浓度预测主动脉夹层手术患者院内病死率的最佳界值及其敏感度和特异度。结果低氧血症组入室血乳酸浓度、2~6 h血乳酸浓度、乳酸清除率与对照组比较,差异有统计学意义(P<0.01);急性肾损伤组初始血乳酸浓度、2~6 h血乳酸浓度、乳酸清除率与正常肾功能组比较,差异有统计学意义(P<0.01)。ROC曲线下面积为0.88。对于预测院内病死率,血乳酸最佳临界值为6.0 mmol/L,灵敏度为85%,特异性为77%。结论主动脉夹层手术患者血乳酸浓度可作为病情严重程度及预后的监测指标,值得临床关注。

Objectives To study the value of blood lactic acid concentration in predicting the prognosis of patients with acute A-type aortic dissection after surgery. Methods Retrospective study was conducted on the 144 patients who were undergone acute A-type aortic dissection surgery in Shenzhen Sun Yat-sen Cardiovascular Hospital and transferred to intensive care unit（ICU）. Lactic acid concentrations at resuscitation,initial ICU and each 2-6 h were collected. According to the oxygenation index and kidney disease：improving global outcomes （KDIGO） acute renal injury standard,the patients were divided into hypoxemia group,non-hypoxemia group and acute renal injury group, normal renal function group. Duration of mechanical ventilation ,duration of ICU stay and mortality of the patients were recorded. Lactic acid concentration and lactic acid clearance rate were compared between the groups. Receiver operator characteristic curve（ROC） was drawn to analyze the optimal cut-off value,sensitivity and specificity of blood lactic acid concentration to predict the hospital mortality in patients with aortic dissection after surgery. Results There were significant differences of home blood lactic acid concentration ,2-6 h lactic acid concentration and lactic acid clearance rate between hypoxemia group and control group（P〈0.01）. There were significant differences of home blood lactic acid concentration ,2-6 h lactic acid concentration and lactic acid clearance rate between acute renal injury group and normal renal function group （P〈0.01）. The area under the ROC was 0.88. For predicting in-hospital mortality ,the optimal cut-off value of blood lactic acid was 6.0 mmol/L,sensitivity was 85% and specificity was 77%. Conclusions Blood lactic acid concentration in patients with aortic dissection can be used as a monitoring indicator of disease severity and prognosis. It is worthy of clinical attention.