乳酸与碱剩余评估法洛四联症患儿预后的价值研究

Lactate and base excess as predictors of mortality in patients with Tetralogy of Fallot

目的探讨法洛四联症手术后血乳酸与碱剩余变化规律及其对治疗和预后评估的指导意义。方法回顾性分析法洛四联症根治手术后1552例，患儿在麻醉诱导后（T1）、鱼精蛋白中和肝素后（T2）、返回ICU24h（T3）测量血乳酸及碱剩余水平。根据转归分为生存组（1505例）和死亡组（47例）。结果死亡组患儿血乳酸水平在耶对比生存组有明显升高[（7．91±5．76）mmol／L对（1．20±0．51）mmol／L，P〈0．05]，而死亡组碱剩余水平在T3对比生存组明显下降[（-1．91±5．09）mmol／L对（2．52±2．85）mmol／L，P〈0．05]。T3时乳酸水平升高和碱剩余水平降低均为患儿死亡的独立危险因素（P〈0．05）。结论法洛四联症患儿围手术期乳酸及碱剩余水平的监测是评估病情严重程度、指导治疗和判断预后的敏感指标。术后乳酸水平升高和（或）碱剩余水平降低，病死率升高。而T3时乳酸升高及碱剩余水平降低是独立危险因素，显著增加死亡风险。

Objective To explore the distribution of lactate and base excess in children with Tetralogy of Fallot in perio- perative period, its dynamic variation and its relationship with prognosis. Methods Perioperative arterial lactate level was dy- namically monitored in 1 552 children with tetralogy of Fallot. According to the prognosis, 1 505 subjects were assigned to sur- vive group, and 47 subjects to nonsurvive group. The lactate and base excess levels of all subjects were collected after induction （T1） , after protamine administration （T2） , and 24 h （T3） after surgery in the intensive care unit（ ICU ）. Results The pa- tients who could not survive showed significant elevated lactate levels as compared to patients who survived after surgery [ （7.91 ± 5.76） mmol/L vs. （ 1.20± 0.51 ） mmol/L, P 〈 0.05 ]. However, in nonsurvivors, the BE value decreased signifi- cantly in the ICU period in comparison to survivors [ （ - 1.91 ± 5.09） mmol/L vs. （2.52 ± 2.85 ） mmol/L, P 〈 0.05 ]. Logis- tic regression analysis was performed, indicating the elevated lactate and depressed base excess levels measured 24 h after sur- gery were independent risk factors. Conclusion The dynamic monitoring of lactate and base excess levels in the perioperative period in patients with tetralogy of Fallot were sensitive indicators to assess severity, to guide treatments, and for the prognosis. In the perioperative period, when the lactate increased and （or） base excess levels decreased, the mortality rate increased as well. lactate and base excess levels measured 24 h after surgery in the ICU were independent risk factors that significantly in- creased the mortality rate.