葛杨玲 孙巧丹 黄梦迪 冯青青 张胜

[摘要] 目的 探討体外循环心脏术后高乳酸血症预后的影响因素。 方法 选择2017年10月至2020年10月在我院行体外循环心脏术患者53例的临床资料进行回顾性分析。根据预后分为存活组32例与死亡组21例。统计患者一般资料、临床资料，单因素及多因素分析体外循环心脏术后高乳酸血症患者预后的影响因素。 结果 （1）单因素分析结果显示，死亡组术后24 h乳酸峰值显著高于存活组，手术时间、体外循环时间显著长于存活组，术后24 h尿量显著少于存活组，ASA分级Ⅱ～Ⅲ级患者存活率显著高于Ⅳ～Ⅴ级的患者，差异均有统计学意义（P<0.05）。（2）多因素分析结果显示，患者术后24 h乳酸峰值、ASA分级、术前心功能分级是体外循环心脏术后高乳酸血症患者死亡的独立危险因素（OR=9.328、5.995、7.057，P<0.05），而术后24 h尿量≥1500 mL是保护因素（OR=0.107，P<0.05）。结论 体外循环心脏术后高乳酸血症患者死亡率增加，而术后的乳酸水平、术前ASA分级、心功能分级是患者不良预后的独立危险因素，术后24 h尿量是保护因素。

[关键词] 体外循环心脏术;高乳酸血症;ASA分级;心功能分级;24 h尿量

[中图分类号] R654.1          [文献标识码] B          [文章编号] 1673-9701（2021）34-0085-04

[Abstract] Objective To investigate the factors influencing the prognosis of hyperlactatemia after cardiac surgery with cardiopulmonary bypass. Methods The clinical data of 53 patients who underwent cardiac surgery with cardiopulmonary bypass in our hospital from October 2017 to October 2020 were retrospectively analyzed. According to prognosis， they were divided into the survival group （n=32） and the death group （n=21）. The general data and clinical data were statistically analyzed. The prognostic factors of patients with hyperlactatemia after cardiac surgery with cardiopulmonary bypass were analyzed by univariate and multivariate analysis. Results （1） Univariate analysis showed that the peak value of lactate at 24 hours after operation in the death group was significantly higher than that in the survival group， the operation time and cardiopulmonary bypass time were significantly longer than those in the survival group， the urine volume at 24 hours after operation was significantly less than that in the survival group， and the survival rate of ASA grade Ⅱ-Ⅲ patients was significantly higher than that of Ⅳ-Ⅴ patients， and the differences were statistically significant （P<0.05）. （2）The results of multivariate analysis showed that peak lactate at 24 hours after surgery， ASA classification， and preoperative cardiac functional classification were independent risk factors for death in patients with hyperlactatemia after cardiac surgery with cardiopulmonary bypass （OR=9.328， 5.995， 7.057， P<0.05）， while urine volume ≥1500 mL at 24 hours after surgery was a protective factor （OR=0.107， P<0.05）. Conclusion The mortality of patients with hyperlactatemia after cardiac surgery with cardiopulmonary bypass is increased. The postoperative lactate level， preoperative ASA classification and cardiac functional classification are independent risk factors for poor prognosis， and postoperative 24 h urine volume is a protective factor.

[Key words] Cardiopulmonary bypass cardiac surgery; Hyperlactatemia; ASA classification; Cardiac functional classification; 24 h urine volume

体外循环心脏是将人体内的静脉血经导管引出至体外，经过氧合后使静脉血转变为动脉血，然后再经导管将其输入到人体的循环系统内，完成血液循环。体外循环是一个非生理状态，对机体构成异常刺激，激发机体释放大量的炎症因子，导致心脏损伤、呼吸功能衰竭、肾功能衰竭等，其中术后出现高乳酸血症是常见的并发症之一。乳酸是一种羧酸，正常情况下不会异常升高，当组织缺氧时导致乳酸升高。有研究显示，体外循环心脏术后高乳酸血症可增加患者的死亡率，而引起高乳酸血症的因素包括急诊手术、高血糖、低血压、体外循环时间等[1]。纠正这些高危因素，预防高乳酸血症的发生可降低早期死亡率。本研究分析体外循环心脏术后高乳酸血症预后的影响因素，以期为临床提供参考，现报道如下。……