【摘要】 目的 探讨体外生命支持（extracorporeal life support,ECLS）期间乳酸水平和清除率与老年心脏重症监护患者死亡的假定相关性。方法 回顾性纳入2019年3月至2024年10月在中南大学湘雅医学院附属长沙医院重症医学科接受ECLS的老年心脏重症监护患者93例，以管理重大心脏手术后的低心排综合征，根据受试者院内结局分为死亡组45例和存活组48例。自ECLS治疗开始，每隔4 h进行血乳酸测量，计算乳酸峰值及乳酸清除率（lactate clearance rate,LCR）。记录常规重症监护病房评分[序贯性器官功能衰竭评分（sequential organ failure score,SOFA）和反应器官功能不全评分（reflects organ dysfunction score,ROD）]和术后并发症。结果 死亡组红细胞浓缩液、新鲜冷冻血浆、血小板浓缩液、去甲肾上腺素、肾上腺素、再开胸、溶血比例明显高于存活组（P<0.05,P<0.01）。死亡组ECLS结束时SOFA和ROD明显高于存活组（P<0.01）。死亡组接受静脉动脉型ECSL后乳酸水平均明显高于存活组（P<0.05, P<0.01）。死亡组乳酸峰值明显高于存活组，LCR低于存活组（P<0.01）。多因素logistic回归分析显示，乳酸峰值和LCR是患者预后的影响因素（P<0.05,P<0.01）。乳酸峰值、LCR单独预测患者预后的ROC曲线下面积分别为0.723(95%CI:0.615～0.831)和0.846(95%CI:0.761～0.932)。乳酸峰值和LCR联合预测院内死亡的ROC曲线下面积为0.846(95%CI:0.762～0.931)，敏感性为0.629，特异性为0.937。结论 ECLS期间乳酸水平和清除率会影响患者生存率，乳酸峰值及LCR可以预测老年心脏重症监护患者预后情况，可以作为预后指标进行临床监测。更多还原

【Abstract】 Objective To investigate the presumed correlation between lactate level and clearance during extracorporeal life support(ECLS) and death in elderly cardiac intensive care patients. Methods A total of 93 elderly cardiac intensive care patients who received ECLS in Department of Critical Care Medicine, Xiangya Medical College Affiliated Changsha Hospital, Central South University, from March 2019 to October 2024 were retrospectively included to manage low cardiac production syndrome after major cardiac surgery. According to hospital outcomes, the patients were divided into a death group(n=45) and a survival group(n=48). Blood lactate measurements were performed every 4 hours from the beginning of ECLS treatment to calculate peak lactate and lactate clearance rate(LCR). Routine ICU scores, such as sequential organ failure score(SOFA) and reactive organ dysfunction(ROD) score, and postoperative complications were recorded. Results The death group received larger amounts of packed red blood cell concentrate, fresh frozen plasma and platelet concentrate, and exhibited higher ratios of norepinephrine and epinephrine administration and higher incidences of re-thoracotomy and hemolytic episodes when compared with the survival group(P<0.05, P<0.01). At the end of ECLS, higher SOFA and ROD scores were observed in the death group(P<0.01). The death group also demonstrated higher lactate level from venoarterial ECLS(P<0.001) and increased median peak lactate level, but lower median LCR than the survival group(P<0.01). Multivariate logistic analysis showed that peak lactate and LCR were independent prognostic factors in the elderly cardiac ICU patients(P<0.05, P<0.01). The AUC value(95%CI) of peak lactate and LCR in predicting patient outcomes was 0.723(95%CI:0.615-0.831) and 0.846(95%CI:0.761-0.932), respectively, and the value of their combination in predicting in-hospital death was 0.846(95%CI:0.762-0.931), with a sensitivity of 0.629 and a specificity of 0.937. Conclusion Lactate level and its clearance rate during ECLS can affect the survival rate of elderly cardiac intensive care patients. Peak lactate and LCR can predict the prognosis of elderly cardiac intensive care patients, and can be used as prognostic indicators for clinical monitoring.更多还原