急诊神经外科手术患者术中血乳酸影响因素的回顾性分析

Retrospective analysis of factors influencing blood lactate in patients undergoing emergency neurosurgery

目的研究麻醉手术过程中常见监测指标对血乳酸(Lac)的影响。方法选择我院2016年4月至2019年5月急诊神经外科手术患者103例,男59例,女44例,年龄18~87岁,BMI 18~35 kg/m^2,ASAⅢ或Ⅴ级,采集麦迪斯顿手术麻醉信息系统麻醉记录单中患者一般资料及术中血气分析结果,记录患者术中Lac、Hb、血糖(Glu)、MAP、HR、休克指数(SI),以Lac为应变量,其他指标作为自变量,通过多重线性回归分析方法分析其线性关系,并通过逐步回归分析方法筛选较理想的多重线性回归方程,筛选对Lac有统计学意义的自变量。结果 Lac与Hb、Glu和SI存在正相关关系,Lac与各自变量之间多重线性回归方程有统计学意义(r^2=0.427,P=0.003)。通过逐步回归分析后得到仅有Hb(P<0.001)、Glu(P<0.05)和SI(P=0.018)的回归模型。结论急诊神经外科患者术中Lac与Hb、Glu及SI存在一定的线性关系,术中做好上述指标管理有利于减少患者高乳酸血症的发生,实现对患者的精细化管理。

Objective To study the effect of common monitoring indicators on blood lactate during anesthesia surgery.Methods A total of 103 cases of emergency neurosurgery in recent two years were selected.Among them,59 were male,44 were female,aged 18-87 years,BMI 18-35 kg/m 2,falling into ASA physical statusⅢorⅤ.The general data and blood gas analysis results were collected from the anesthesia record sheet of the Medical Anesthesia Information System,and the intraoperative blood lactic acid(Lac),hemoglobin(Hb),blood glucose(Glu),mean arterial pressure(MAP),heart rate(HR),shock index(SI),gender,age,BMI were recorded.Their linear relationship was analyzed by multiple linear regression analysis.The multiple linear regression equation was selected by stepwise regression analysis,and the independent variables with statistical significance were selected.Results There was a positive correlation between Lac and Hb,Glu and SI.The multiple linear regression equations between Lac and their respective variables were statistically significant(r 2=0.427,P=0.003).A regression model containing only Hb,Glu,and SI was obtained through stepwise regression analysis,among which Hb(P<0.001),Glu(P<0.018)and SI(P=0.018)were statistically significant.Conclusion There is a certain linear relationship between intraoperative Lac and Hb,Glu level and SI patients with emergency neurosurgery.The management of these indicators during operation is beneficial to reduce the occurrence of hyperlactatemia and achieve refined management of the patients.