小儿复杂先天性心脏病体外循环术后血乳酸浓度与脓毒症的关系

摘要

Objective To investigate the possible association of blood lactic acid concentration and occurrence of post-operative sepsis in complicated congenital heart disease patient treated with surgery under cardiopulmonary bypass (CPB).Methods From Jan.2012 to May.2014,114 pediatric patients (59 males,55 females)who were operated in our institute were enlisted in this retrospective study and divided into three following groups by blood lactic acid level:normal lactic acid level group ( <2.25 mmol/L),high lactic acid level group(≥2.25 mmol/L and≤5 mmol/L) and lactic acid intoxication group ( >5 mmol /L).The CPB time,cross-clamping time,post-operative lactic acid level and the occurrence of sepsis were recorded and compared among groups . Results Compared with normal lactic acid level group and high lactic acid level group ,CPB time,cross-clamping time and incidence of sepsis were higher in the lactic acid intoxication group ( P <0.05 ).No difference were observed between normal lactic acid level group and high lactic acid level group (P >0.05).Conclusions In pediatric patient with complicated congenital heart disease treated by surgery under CPB ,high post-operative lactic acid level is associated with increased risk of sepsis .%目的观察小儿复杂先天性心脏病体外循环术后血乳酸浓度与术后脓毒症发病率的临床相关性。方法回顾性分析我院2012年1月至2014年5月手术治疗复杂先天性心脏病小儿114例，男59例，女55例，年龄（6．17±3．19）个月，体重（6．54±1．61）kg，身高（63．79±8．48）cm，记录病例的体外循环时间、主动脉阻断时间、术后乳酸浓度、术后脓毒症发病情况。分为正常乳酸组（＜2．25 mmol/L，n ＝44）、高乳酸组（≥2．25 mmol /L 并≤5 mmol /L，n ＝41）、乳酸酸中毒组（＞5 mmol/L，n ＝29），比较分析各组之间各指标的差异。结果乳酸酸中毒组的体外循环时间、主动脉阻断时间、脓毒症发病率分别高于正常乳酸组和高乳酸组（均 P ＜0．05），而正常乳酸组和高乳酸组之间无统计学差异（P ＞0．05）。结论复杂先天性心脏病小儿在体外循环下行心脏畸形矫正术，术后乳酸浓度明显升高时并发脓毒症的风险增高。