婴幼儿先天性心脏病围手术期血乳酸值的变化.docVIP

于2008.12.25已投打印稿件，现附上电子邮件版，谢谢 婴幼儿先天性心脏病围手术期血乳酸值的变化 【摘 要】　 目的 探讨婴幼儿先天性心脏病围手术期动脉血乳酸浓度动态变化的规律及与疾病预后的关系。方法　检测78例婴幼儿先天性心脏病患者在术前、体外循环转流停止、术后3h、术后6 h、术后12h及术后24 h的动脉血乳酸含量。按疾病严重程度不同的病种、体外循环转流时间长短、存活与否分组。结果　法乐氏四联症（TOF）、法乐氏三联症、心内膜垫缺损、右室双出口、完全性大动脉错位、完全性肺静脉异位引流等复杂先天性心脏病组较房间隔缺损（ASD）、室间隔缺损（VSD）、肺动脉狭窄（PS）等简单先天性心脏病组，术后各相同时间点，复杂先天性心脏病组的血乳酸值均高于简单先天性心脏病组(P0. 01)。转流时间大于120min组术后血乳酸值高于转流时间短的组 (P0. 05)。术后死亡组各时点的血乳酸值均明显高于存活组(P0. 01)。存活组和死亡组的乳酸值在体外循环转流结束时最高,存活组的乳酸值明显逐渐降低,死亡组的乳酸值下降不明显(P0. 01)。结论　检测婴幼儿先天性心脏病患者的围术期血乳酸浓度的变化可以作为评价疾病预后的一个敏感性指标。血乳酸水平越高，且长时间不能恢复者，预后越差。 【关键词】血乳酸值；心脏手术；预后 Variation of the blood lactate perioperatively in the infants congenital heart disease 【Abstract】 Objective To observe blood lactate concentration and the dynamic changes in the infants with congenital heart disease perioperative and prognosis. Methods Detection the arterial blood lactate concentration of 78 cases of infants with congenital heart disease in patients with pre-operative, to stop cardiopulmonary bypass, after 3h, 6 h, 12h and 24 h. Patients have been divided into two groups according to the severity of the different diseases, the duration of cardiopulmonary bypass, survival or not. Results The group of TOF, Fallots triad, endocardial cushion defect, double outlet right ventricle, complete transposition of the great arteries, total anomalous pulmonary venous drainage, and other complex congenital heart disease compared to the group of ASD, VSD, PS, and other simple congenital heart disease group, The blood lactate values of the complex congenital heart disease group were higher than the values in the simple congenital heart disease group (P 0. 01). The blood lactate values in the duration of the cardiopulmonary bypass more then 120 min higher than the values in others (P 0. 05). The blood lactate values in the death group were significantly higher than values in the survival group (P 0. 01). At the end of the cardiopulmonary bypass , the lactate rose the highest in both survival and death