在选择性非心脏手术队列中进行术后的高乳糖血和术前心肺运动测试:一项回顾性观察性研究
Christopher Darwen1, Angella Bryan1,2, Tanviha Quraishi-Akhtar1,2
1Manchester University NHS Foundation Trust, Manchester, UK.
BJA open
|August 17, 2023
概括
手术后高血乳酸水平和手术前异常心肺运动测试 (CPET) 预测主要非心脏手术后的死亡率. 这些标记物的结合显著增加了30天死亡率的风险.
科学领域:
- 麻醉学和重症监护医学
- 手术风险分层的分层化
- 生理压力的生物标志物
背景情况:
- 手术后血液中乳酸度表明生理压力,并预测并发症.
- 心肺运动测试 (CPET) 是手术前风险评估的标准工具.
- 了解术前CPET和术后乳酸之间的相互作用对于预测结果至关重要.
研究的目的:
- 调查手术前CPET结果和术后乳酸盐水平与重大非心脏手术后死亡率之间的关联.
- 确定这些因素是否独立预测术后死亡率.
- 为了评估CPET和乳酸对死亡率的综合预测值.
主要方法:
- 分析了从1075名接受重大非心脏手术的患者的数据,包括手术前的CPET和手术后的乳酸测量.
- 利用单变量和多变量分析来评估与死亡率的关联.
- 研究了乳酸度和CPET变量 (CO2的呼吸器等效) 对30天和90天死亡率的影响.
主要成果:
- 术后乳酸水平升高 (>2 mM) 与30天死亡率的增加有显著关联 (ORs在3.9至6.1之间).
- 在手术前的CPET中,低CO2通风等值 (VE/VCO2;切断点34) 也预测了30天死亡率的增加 (OR 2.5).
- 超乳糖血和低VE/VCO2独立预测死亡率,联合效应为30天死亡率的OR为11.53.
结论:
- 手术后的高乳糖血是主要非心脏手术后死亡的独立预测因素.
- 手术前的CO2低通风等价也与手术后死亡率的增加独立相关.
- 这两种标记物的结合为患者的结果提供了强大的预测工具.
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