Analysis Of Prognosis And Influencing Factors In Patients With Severe Hyperlactatemia After Cardiac Surgery

Objective: Previous studies have shown that patients with severe hyperlactatemia(>8mmol/L)have almost no survival,and hyperlactatemia is one of the common complications after cardiac surgery.Nowadays,medical technology,equipment and drugs are constantly updated,and the medical level is constantly improving.Is the mortality rate of patients with severe hyperlactatemia still high? What are the factors that affect the outcome of patients with severely high lactate? In order to solve the above problems,this study retrospectively observed the clinical information of patients undergoing cardiac surgery under cardiopulmonary bypass,and collected preoperative basic data,various intraoperative and postoperative factors for analysis.The aim is to clarify the incidence and causes of severe hyperlactatemia after surgery,the prognosis of patients with severe hyperlactatemia,and the factors affecting their outcome,in order to reduce the mortality of patients with severe hyperlactatemia after cardiac surgery.Provide clinical trial basis for improving patient prognosis and improving quality of life.Methods:1.The case selection: A retrospective analysis was performed on 491 patients undergoing cardiopulmonary bypass assisted cardiac surgery in The First Affiliated Hospital of Dalian Medical University from August 2016 to August 2018.The included cases were divided into the peak of arterial lactate within 24 hours after surgery: group A(lactic acid peak ? 8mmol / L),group B(lactic acid peak > 8mmol / L).Group B was a group with severe hyperlactatemia,which was divided into death group and survival group according to prognosis.Inclusion criteria:(1)Age between 18-80 years old.(2)ASA grade ?-?.(3)Patients with cardiopulmonary bypass assisted cardiac surgery.(4)The duration of postoperative cardiac ICU stay ? 24 hours.Exclusion criteria:(1)patients with extremely severe hyperlactatemia due to sepsis,severe burns,etc.before surgery.2 Incomplete data of the case affects the judge.2.Data collection: age,gender,height,weight,ASA grade,NHYA,comorbidities,surgical procedures,time of surgery,time of cardiopulmonary bypass,preoperative left ventricular ejection fraction,postoperative left ventricular ejection fraction,partial perioperative serum lactate value,ICU readmission,postoperative urine volume within 24 hours,mortality,postoperative vital signs,ICU drug use within 24 hours(including adrenaline,norepinephrine,vasopressin,nicardipine,esmolol,insulin,nitroglycerin,diuretic,sodium bicarbonate),24 The use of ICU treatment in the hour(IABP,renal replacement therapy,secondary surgery).Results: 1.Among the patients,95.9% of patients had elevated arterial lactate(>2mmol/L).The mean maximum value of postoperative arterial lactate was 4.51 mmol/L,and the highest lactic acid concentration occurred at 6 h after surgery.55.7% of the patients returned to normal within 24 h after surgery.The overall mortality rate was 3.9%,6.1% of patients had severe hyperlactatemia(>8 mmol/l),the mortality rate was 23.3%,and the mortality rate of patients without severe high lactic acid was 2.6%.Severe hyperlactatemia Patient mortality was significantly elevated(P=0.014).2.ASA grade(P=0.000),cardiac function grade(P=0.028),large vessel surgery(with or without valve surgery)(P=0.001),length of surgery(P=0.000),duration of cardiopulmonary bypass(P= 0.000)was a risk factor for severe high lactic acid after surgery.Patients in group B were significantly longer(P=0.038)and significantly higher in mortality than in group A(P=0.014).3.ASA classification,cardiac function grading,large vascular surgery(with or without valve replacement),extracorporeal circulation duration,and length of surgery are independent risk factors for severe hyperlactatemia in patients.4.The following factors were statistically different between the death group and the survival group: torasemide(mg)(P = 0.011),total urine volume(ml)24 hours after surgery(P = 0.003),postoperative IABP application(P=0.003).The amount of vasoactive drugs used was not statistically different between the two groups(all P>0.05).5.The mean arterial lactate values were higher in the death group than in the survival group.6.Total urine volume reduction and postoperative IABP use at 24 hours postoperatively were independent risk factors for death in patients with severe hyperlactatemia.Conclusion: In this study,the incidence of severe hyperlactatemia after cardiac surgery was 6.1%,and the mortality rate was 23.3%,which was significantly higher than the total mortality rate of 3.9%.Lactate remains an important indicator of prognosis.Factors such as ASA grading,cardiac function grading,large vascular surgery(with or without valve replacement),extracorporeal circulation duration,and length of surgery were independently associated with the development of severe hyperlactatemia.The amount of urine is positively correlated with the outcome of patients with severe hyperlactatemia.Even if the absolute value of lactate is high,as long as the urine volume is normal,it usually returns well.After cardiac surgery,the use of IABP often does not improve prognosis in patients with severe hyperlactatemia.Observation of postoperative lactic acid change trend is more meaningful than the peak lactate on the prognosis of patients.Whether the use of vasoactive drugs(including large doses)has no effect on the outcome of hyperlactatemia.