术后血糖和乳酸评估体外循环手术预后的比较

目的比较血糖、乳酸在判断体外循环手术预后方面的差异,探寻预后的适宜预测方法。方法连续选择159例18岁以上体外循环手术患者。收集术中最高血糖、乳酸,术后0、4、8、12、18、24、36、48 h静脉血糖和动脉乳酸检测结果及相关临床资料。结果术后血糖升高组（≥11.1mmol/L）48例,正常组111例;乳酸升高组（≥4mmol/L）40例,正常组119例。并发症34例,死亡9例。经Logistic多元回归得出术后血糖（回归系数-0.4682）、乳酸（回归系数-0.3068）与并发症呈正相关,且与术后血糖关系更大;死亡只与术后血糖（回归系数-0.390）有关。术后血糖、乳酸与循环、呼吸系统并发症发生率有关,且术后乳酸与循环系统并发症关系更大,术后血糖与呼吸系统并发症关系更大,术后血糖是与神经系统并发症有关的唯一指标。结论术后血糖、乳酸与体外循环手术的预后有统计学关系,而乳酸与循环系统并发症关系更大,血糖与呼吸系统、神经系统关系更大。

Prognostic evaluation of serum glucose and lactid acid on CPB surgery

Objective To compare the prognostic evaluation of serum glucose and lactid acid on CPB surgery.Method 159 consecutive adult patients underwent CPB surgery were enrolled to the study.Arterious lactic acid and venous blood glucose were measured during operation and on 0h,4h,8h,12h,18h,24h,36h and 48h after operation.Result The highest blood glucose level was used to classify patients as normal group（〈11.1mmol/L,111 patients） and abnormal group（≥11.1 mmol/L,48 patients）.The highest lactic acid was used to classify patients as the normal group（〈4mmol/L,119 patients） and the abnormal group（≥4 mmol/L,40 patients）.34 cases had complications and 9 cases died.It can be found from Logistic multiple regression that postoperative blood glucose（regression coefficient=-0.4682）,lactic acid（regression coefficient=-0.3068） and complications formed positive correlation.Conclusion Postoperative highest blood glucose and lactic acid have statistics relation with prognosis of CPB surgery,which were good evaluative indexes of prognosis.