冠状动脉旁路移植术后高乳酸血症影响因素研究

A clinical research of factors relating to hyperlactatemia for post CABG patient

目的探讨冠状动脉旁路移植（CABG）术后患者发生高乳酸血症的影响因素，以及术后高乳酸血症与并发症、患者预后的关系。方法收集2016年3月至2016年10月CABG术后返ICU的1280例患者资料，根据术后是否出现高乳酸血症，分为高乳酸血症组（术后动脉血乳酸峰浓度≥3．0mmol/L，511例）和非高乳酸血症组（术后动脉血乳酸峰浓度〈3．0mmol/L，769例）。记录两组患者性别、年龄、相关病史、心功能等因素，对比术后肝肾功能、二次气管插管率、气管切开率、病死率、主动脉内球囊反搏（IABP）及体外膜肺氧合（ECMO）使用率、ICU停留和住院时间等。结果相较于非高乳酸血症组，高乳酸血症组术后二次气管插管率（P=0．003）和气管切开率（P=0．035）高，术后机械通气时间（P=0．009）长，住院病死率（P=0．000）高，ICU停留（P=0．039）及住院时间（P=0．047）长。多因素回归分析发现：术前应用IABP（P=0．040）、术后心源性休克（P=0．030）、术后发生急性肾损伤（AKI，P=0．020）和术后肝功能衰竭（P=0．039）是CABG患者术后发生高乳酸血症的独立危险因素；乳酸峰浓度时间〉30h（P=0．021）、术后发生AKI3期（P=0．030）、术后肝功能衰竭（P=0．025）和术后心源性休克（P=0．037）是CABG术后高乳酸血症患者住院死亡的独立危险因素。结论CABG术后持续性高乳酸血症患者病死率高，及时改善心脏等重要脏器功能并清除乳酸可降低病死率，改善患者预后。

Objective To research the factors relating to hyperlactatemia and its connections to certain combinations and the motality of post CABG patients. Methods Splitting the 1 280 cases of post OPCABG surgery patient admitted to ICU of Anzhen Hospital between March 2016 and October 2016 into two groups, including a hyperlactatemia group of 511 patients [ 340 males and 171 females, aged（63.81 _＋ 9.1 ）years ], and a none-hyperlactatemia group of 769 samples [ 499 males and 270 females, aged（61.72 ＋ 8.97 ） years ]. Recording the pre-operative characteristics such as gender, age, medical history, heart function, and post-operative characteristics such as liver and kidney function, reintubation rate, tracheotomy treatment rate, mortality rate, IABP and ECMO usage rates, ICU and hospital stay time. Results As compare to the none-hyperlac- tatemia group, the hyperlactatemia group has ： （ 1 ） higher reintubation rate （ P = 0. 003 ） and higher tracheotomy rate （ P = 0. 035 ） ; （2） longer mechanical ventilation time （ P = 0. 009） ; （ 3 ） higher mortality rate （ P = 0. 000） ; （4） longer ICU stay time （P = 0. 039） and hospital stay time（ P = 0. 047 ）. Multi factor regression discovered： pre-operative IABP（ P = 0. 040 ）, postoperative cadiogenic shock （ P = O. 030）, post-operative AKI （ P = 0. 020）, post-operative liver failure （ P = 0. 039） are the in- dependent risk factors for post-operative hyperlactatemia of CABG patient; peak lactate time 〉 30 h （P = 0. 021 ）, post-opera- tive level 3 AKI （ P = 0. 030）, post-operative liver failure （ P = 0. 025 ）, post-operative cardiogenic shock （ P = 0. 037 ） are the independent risk factors for mortality of CABG post-operative hyperlactatemia patient. Condttsion After CABG operation, hyperlaetatemia patients had a higher mortality rate. Timely restoring heart and important organ function to remove lactate so to reduce mortality rate is advised.