婴幼儿围心脏手术期血乳酸浓度的变化与预后

目的 探讨婴幼儿围心脏手术期血乳酸浓度的变化与疾病预后的关系.方法 1227例体外循环（extracorporeal circulation,ECC）下实施手术的小儿先天性心脏病患者,常规测定术前、ECC前、ECC 30min、ECC停止1h、术后24h及术后48h的动脉血乳酸含量.比较按年龄、存活与否、小儿恢复室（PICU）滞留时间分组后的血乳酸值.结果 存活组和死亡组的乳酸值在ECC后最高,以后逐渐降低,两组各时点的血乳酸值比较,死亡组明显高于存活组（P＜0.05）.滞留9天以内的各组间血乳酸值无显著性差异,滞留9天以上组术前、ECC前、术后24 h、48 h时点明显高于其它各组（P＜0.05）.新生儿组及学龄儿组从ECC后1 h到术后24 h血乳酸值明显上升,学龄儿组的高乳酸血症第二天恢复,但新生儿组仍维持在较高水平.结论 测定婴幼儿先天性心脏病患者的围术期血乳酸浓度的变化可以作为评价疾病预后的一个敏感性指标.

Changes of Lactic Acid and Prognosis of Diseases During Cardiac Surgery in Infants

OBJECTIVE To study the changes of lactic acid and prognosis of diseases during cardiac surgery in infants.METHODS 1227 infants with congenital heart disease were receved cardiac surgery suffer extracorporeal circulation(ECC).Artery blood samples were drawed and the concentration of lactic acid were measured at pre-operation,before ECC,at 30minutes after ECC.and 24,48 hours after the termination of operation.The concentration of lactic acid were compared between groups divided according to the ages,alive or dead,the stay time in PICU.RESULTS The concentration of lactic acid were at peak at the point of 30minutes after ECC,then decreased gradully in alive and dead group.The plasma levels of lactic acid in group alive decreased compared with group dead at each point.There were no significant difference of the concentration between the groups stayed in PICU less than 9 days.In group stayed in PICU more than 9 days,the concentration were increased compared to other groups at the point of pre-operation,before ECC,at 30minutes after ECC.and 24,48 hours after the termination of operation.The concentration increased significantly between after 1 hour of ECC to 24 hours after the termination of operation in newborn group and schoolage group,the level of lactic acid resumed in schoolage group while remained high in newborn group the next day.CONCLUSION It is a sensitive index to measure the concentration change of lactic acid to predict the prognosis of infants,receved cardiac surgery during operation.