文章摘要
方 炜,胡英超,王雪芹,陈莉莉,丁 力.体外循环下先天性心脏病患儿血糖及动脉血乳酸水平的变化及临床意义[J].,2021,(8):1563-1567
体外循环下先天性心脏病患儿血糖及动脉血乳酸水平的变化及临床意义
Changes of Blood Glucose and Arterial Lactic Acid Levels in Children with Congenital Heart Disease Under Extracorporeal Circulation and Its Clinical Significance
投稿时间:2020-07-30  修订日期:2020-08-23
DOI:10.13241/j.cnki.pmb.2021.08.036
中文关键词: 体外循环  先天性心脏病  血糖  乳酸  预后  危险因素  预测价值
英文关键词: Cardiopulmonary bypass  Congenital heart disease  Blood glucose  Lactate  Prognosis  Risk factors  Predictive value
基金项目:安徽省科技厅科研基金项目(1604f0805119)
作者单位E-mail
方 炜 安徽省儿童医院心外科 安徽 合肥 230051 xwktwxh7437@126.com 
胡英超 安徽省儿童医院心外科 安徽 合肥 230051  
王雪芹 安徽省儿童医院心外科 安徽 合肥 230051  
陈莉莉 安徽省儿童医院心外科 安徽 合肥 230051  
丁 力 安徽省儿童医院心外科 安徽 合肥 230051  
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中文摘要:
      摘要 目的:探究体外循环下先天性心脏病患儿血糖及动脉血乳酸水平的变化及临床意义。方法:回顾性选取2018年1月至2019年12月期间我院诊治的263例先天性心脏病患儿作为研究对象,收集其临床资料,根据患儿预后将患儿分为存活组(n=254)和死亡组(n=9)。分别于体外循环阻断前(T0),体外循环升温时(T1),后平行时(T2)检测两组患儿血糖及动脉血乳酸水平,单因素分析临床各指标与患儿预后的关系,采用Logistic回归分析体外循环下先天性心脏病患儿死亡的影响因素,采用受试者工作特征(ROC)曲线分析血糖、动脉血乳酸对体外循环下先天性心脏病患儿死亡的预测价值。结果:存活组、死亡组T0、T1、T2的血糖和动脉血乳酸水平均持续升高(P<0.05),且死亡组高于存活组(P<0.05)。单因素分析结果显示,死亡组患儿体外循环时间、主动脉阻断时间、住ICU时间长于存活组(P<0.05),肌酐(Cr)水平高于存活组,而平均动脉压(MAP)和动脉氧分压与吸入氧浓度比(PaO2/FiO2)低于存活组(P<0.05)。Logistic回归分析显示血糖、动脉血乳酸是体外循环下先天性心脏病患儿死亡的危险因素(P<0.05)。血糖预测体外循环下先天性心脏病患儿死亡的曲线下面积(AUC)为0.777,最佳截断值为8.46 μmol/L,灵敏度和特异性分别为0.76和0.81;动脉血乳酸预测体外循环下先天性心脏病患儿死亡的AUC为0.877,最佳截断值为3.18 μmol/L,灵敏度、特异性分别为0.81、0.85;血糖联合动脉血乳酸预测体外循环下先天性心脏病患儿死亡的AUC为0.921,灵敏度、特异性分别为0.88、0.91。结论:体外循环下先天性心脏病患儿血糖及动脉血乳酸水平显著升高,并且血糖、动脉血乳酸是体外循环下先天性心脏病患儿死亡的影响因素,二者的联合检测对体外循环下先天性心脏病患儿死亡具有较好的预测价值。
英文摘要:
      ABSTRACT Objective: To investigate the changes and clinical significance of blood glucose and arterial lactic acid levels in children with congenital heart disease under extracorporeal circulation. Methods: 263 children with congenital heart disease who were diagnosed and treated in our hospital from January 2018 to December 2019 were selected as the research objects, and their clinical data were collected. According to their prognosis, the children were divided into survival group (n=254) and death group (n=9). Blood glucose and arterial blood lactate were measured before cardiopulmonary bypass (T0), when cardiopulmonary bypass was heated (T1), and when cardiopulmonary bypass was parallel (T2). The relationship between clinical indexes and prognosis of children was analyzed by single factor analysis. The influencing factors of death of children with congenital heart disease under cardiopulmonary bypass were analyzed by logistic regression. Blood glucose and artery were analyzed by ROC curve The predictive value of blood lactate on the death of children with congenital heart disease under cardiopulmonary bypass. Results: The blood glucose and arterial blood lactate levels of T0, T1 and T2 in the survival group and the death group were all increased continuously (P<0.05). and the death group was higher than the survival group (P<0.05). The results of univariate analysis showed that the time of cardiopulmonary bypass, aortic occlusion and ICU stay in the dead group were longer than those in the alive group (P<0.05), Creatinine (CR) level was higher than that of the survival group, but Mean arterial pressure(map), arterial oxygen partial pressure to inhaled oxygen concentration ratio (PaO2/FiO2) were lower than that of the survival group (P<0.05). Logistic regression showed that blood glucose and arterial blood lactate were the risk factors of death in children with congenital heart disease under cardiopulmonary bypass (P<0.05). The AUC of blood glucose in predicting the death of children with congenital heart disease under cardiopulmonary bypass is 0.777, the best cutoff value is 8.46 μmol/L, the sensitivity and specificity were 0.76 and 0.81 respectively; the AUC of arterial blood lactate in predicting the death of children with congenital heart disease under cardiopulmonary bypass is 0.877, the best cutoff value is 3.18 μmol/L, the sensitivity and specificity are 0.81 and 0.85 respectively, the AUC of blood glucose combined artery was 0.81 and 0.85 respectively, The AUC of blood lactate was 0.921, the sensitivity and specificity were 0.88 and 0.91 respectively. Conclusion: The level of blood glucose and arterial blood lactate in children with congenital heart disease increased significantly under cardiopulmonary bypass, and blood glucose and arterial blood lactate were the influencing factors of the death of children with congenital heart disease under cardiopulmonary bypass. The combined detection of the two has a better predictive value for the death of children with congenital heart disease under cardiopulmonary bypass.
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