【原】【罂粟摘要】​体外循环期间对患者进行目标血压管理可改善其心脏手术后的血乳酸水平:一项随机对照试验

体外循环期间对患者进行目标血压管理可改善其心脏手术后的血乳酸水平:一项随机对照试验

贵州医科大学 麻醉与心脏电生理课题组

翻译：张中伟    编辑：潘志军    审校：曹莹

1

  背景

高乳酸血症与心脏手术后患者的预后不良有关。这项研究探讨了体外循环(CPB)期间的目标血压管理对心脏手术后患者的血乳酸水平的影响。

2

  方法

本研究纳入了2020年1月20日至2020年6月30日在上海市胸科医院接受心脏瓣膜置换术的成年患者。将患者随机分为L-MAP(低平均动脉压组,目标动脉压控制在50-60毫米汞柱之间)和H-MAP(高平均动脉压组,目标动脉压控制在70-80毫米汞柱之间)，每组20人。仅在CPB期间持续泵注去甲肾上腺素，以将MAP维持在目标水平。检测两组患者术前(T0)、CPB结束时(T1)、手术结束时(T2)、术后1h(T3)、术后6h(T4)和术后24h(T5)这六个时间点的血乳酸水平。主要观察指标是手术结束时的血乳酸水平(T2)。次要观察指标包括T1、T3、T4和T5时的血乳酸水平以及术后24小时内肾上腺素和多巴胺的用量、拔管时间、在重症监护室的住院时间、30天内再入院率和1年内患者的死亡率。

3

  结果

该研究纳入了40名患者。在手术结束时(3.1 [IQR 2.1，5.0]vs 2.1[IQR 1.7，2.9]，P = 0.008)、CPB结束时以及术后1小时这三个时间点，H-MAP组患者的血乳酸水平明显低于L-MAP组。对于术后24 h内肾上腺素的用量、拔管时间和在重症监护室的住院时间这三个次要观察指标，H-MAP组患者明显低于L-MAP组。

4

  结论

在CPB期间维持相对较高的平均动脉压可降低手术结束时患者的血乳酸水平，减少了肾上腺素的消耗，并缩短了术后拔管时间和患者在重症监护室的住院时间。

原始文献来源 ☟

Qing Miao, Dong Jin Wu, Xu Chen, et al. Target blood pressure management during cardiopulmonary bypass improves lactate levels after cardiac surgery:a randomized controlled trial.[J]. BMC Anesthesiol (2021) 21:309 :1 

---

英文原文

Target blood pressure management during cardiopulmonary bypass improves

lactate levels after cardiac surgery: a randomized controlled trial

Abstract

A

    Introduction:

Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery.

B

    Methods:

Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year.

C

    Results:

Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group.

D

    Conclusion:

Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery.

不 惧 严 寒 , 静 待 花 开

谢谢您的点赞、分享、在看，

欢迎您的精彩评论哦

END

更多精彩，请关注公众号：罂粟花