Научно-практический журнал
«Клиническая физиология кровообращения»

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, директор ФГБУ «НМИЦССХ им. А.Н. Бакулева» МЗ РФ

Гиперлактатемия и органная дисфункция в раннем послеоперационном периоде у больных с приобретенными пороками сердца

Авторы: Юдин Г.В., Гончаров А.А., Рыбка М.М., Дибин Д.А., Ломакин М.В., Хинчагов Д.Я.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» (президент – академик РАН и РАМН Л.А. Бокерия) Минздрава России, Рублевское ш., 135, Москва, 121552, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Гематология

DOI: https://doi.org/10.24022/1814-6910-2020-17-4-319-328

УДК: 616.12-007.1-083.98

Библиографическая ссылка: Клиническая физиология кровообращения. 2020; 4 (17): -

Цитировать как: Юдин Г.В., Гончаров А.А., Рыбка М.М., Дибин Д.А., Ломакин М.В., Хинчагов Д.Я.. Гиперлактатемия и органная дисфункция в раннем послеоперационном периоде у больных с приобретенными пороками сердца. Клиническая физиология кровообращения. 2020; 4 (17): -. DOI: 10.24022/1814-6910-2020-17-4-319-328

Ключевые слова: гиперлактатемия, органная дисфункция, приобретенные пороки сердца

Полнотекстовая версия:
Оформить подписку 🔒

Аннотация

Objective. To study the frequency and character of organ dysfunction in the early postoperative period and the possibility of using serum lactate concentration as a screening-test for organ damage in patients in the first postoperative day after correction of heart valves defects.

Material and methods. A single-center retrospective study of 3919 patients who were primarily operated on heart valves. The analysis of the frequency and structure of organ dysfunction in the early postoperative period was carried out, and the ROC-analysis of the diagnostic significance of serum lactate concentration immediately after the operation and the maximum lactate concentration in the first postoperative day as a marker of organ damage was performed.

Results. The incidence of acute heart failure (AHF) was 6.6%, cerebral dysfunction (CD) – 2.8%, hepatic dysfunction (HD) – 9.1%, acute kidney injury (AKI) stage 3 AKIN (Acute Kidney Injury Network) – 2.3%, dysfunction of oxygenating lung's function – 9.8%, hemostatic system dysfunction – 0.2%, multiorgan dysfunction (MOD) – 4.6%. Postoperative mortality was 4.4%. The lactate concentration immediately after the operation 4.5 mmol/l reflected the presence of AHF with a sensitivity of 78% and specificity of 61% in other cases of organ damage the concentration of lactate after operation and the maximum level of lactatemia in the first postoperative day had a low predictive value and had a sensitivity lower than 75%, specificity lower than 64%.

Conclusion. The level of lactatemia of 4.5 mmol/l and higher immediately after the operation reflects the presence of AHF in patients with heart valves defects with sensitivity of 78%, specificity of 61%. The concentration of lactate after the operation and the maximum level of lactatemia in the first postoperative day can not be used as markers of CD, HD, AKI stage 3 AKIN, MOD in patients operated on heart valves due to their low sensitivity and specificity.

Литература

  1. Рыбка М.М. Аспекты патогенеза синдрома полиорганной недостаточности у кардиохирургических пациентов. Клиническая физиология кровообращения. 2016; 13 (2): 65–74.
  2. Andersen L.W., Holmberg M.J., Doherty M., Khabbaz K., Lerner A., Berg K.M. et al. Postoperative lactate levels and hospital length of stay after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2015; 29 (6): 1454–60. DOI: 10.1053/j.jvca.2015.06.007
  3. Торшин В.А. Уровень лактата крови как показатель STAT-анализа. Лаборатория. 2001; 4: 17–9.
  4. Fuller B.M., Dellinger R.P. Lactate as a hemodynamic marker in the critically ill. Curr. Opin. Crit. Care. 2012; 18 (3): 267–72. DOI: 10.1097/MCC.0b013e3283532b8a
  5. Kubiak G.M., Tomasik A.R., Bartus K. Lactate in cardiogenic shock – current understanding and clinical implications. J. Physiol. Pharmacol. 2018; 69 (1): 15–21. DOI: 10.26402/jpp.2018.1.02
  6. Laine G.A., Hu B.Y., Wang S., Solis T.R., Reul G.J. Jr. Isolated high lactate or low central venous oxygen saturation after cardiac surgery and association with outcome. J. Cardiothorac. Vasc. Anesth. 2013; 27 (6): 1271–6. DOI: 10.1053/j.jvca.2013.02.031
  7. Minton J., Sidebotham D.A. Hyperlactatemia and cardiac surgery. J. Extra Corpor. Technol. 2017; 49 (1): 7–15. 8. Fall P.J., Szerlip H.M. Lactic acidosis: from sour milk to septic shock. J. Intens. Care Med. 2005; 20 (5): 255–71. DOI: 10.1177/0885066605278644
  8. Vincent J.L., Quintairos E., Silva A., Couto L. Jr. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit. Care. 2016; 20 (1): 257. DOI: 10.1186/s13054-016-1403-5
  9. Lopez-Delgado J.C., Esteve F., Javierre C. Evaluation of serial arterial lactate levels as a predictor of hospital and long-term mortality in patients after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2015; 29 (6): 1441–53. DOI: 10.1053/j.jvca.2015.04.024
  10. Shinde S.B., Golam K.K., Kumar P., Patil N.D. Blood lactate levels during cardiopulmonary bypass for valvular heart surgery. Ann. Card. Anaesth. 2005; 8 (1): 39–44.
  11. Hajjar L.A., Almeida J.P., Fukushima J.T., Rhodes A., Vincent J.L., Osawa E.A. et al. High lactate levels are predictors of major complications after cardiac surgery. J. Thorac. Cardiovasc. Surg. 2013; 146 (2): 455–60. DOI: 10.1016/j.jtcvs.2013.02.003
  12. Lindsay A.J., Xu M., Sessler D.I., Blackstone E.H., Bashour C.A. Lactate clearance time and concentration linked to morbidity and death in cardiac surgicalpatients. Ann. Thorac. Surg. 2013; 95 (2): 486–92. DOI: 10.1016/j.athoracsur.2012.07.020
  13. Maillet J.M., Le Besnerais P., Cantoni M., Nataf P., Ruffenach A., Lessana A. et al. Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest. 2003; 123 (5): 1361–6. DOI: 10.1378/chest.123. 5.1361
  14. Jabbari A., Banihashem N., Alijanpour E., Vafaey H.R., Alereza H., Rabiee S.M. Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method. Caspian. J. Internal. Med. 2013; 4 (2): 662–6.
  15. Gjedsted J., Buhl M., Nielsen S., Schmitz O., Vestergaard E.T., Tonnesen E. et al. Effects of adrenaline on lactate, glucose, lipid and protein metabolism in the placebo controlled bilaterally perfused human leg. Acta Physiol. (Oxf). 2011; 202 (4): 641–8. DOI: 10.1111/j.1748-1716.2011.02316.x
  16. Badreldin A.M., Doerr F., Elsobky S., Brehm B.R., Abul-dahab M., Lehmann T. et al. Mortality prediction after cardiac surgery: blood lactate is indispensable. Thorac. Cardiovasc. Surg. 2013; 61 (8): 708–17. DOI: 10.1055/s-0032-1324796
  17. James J.H., Luchette F.A., McCarter F.D., Fischer J.E. Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet. 1999; 354 (9177): 505–8. DOI: 10.1016/S0140-6736(98)91132-1
  18. Thuemer O., Schelenz C., Sakka S. Changes in serum lactate, mix-venous oxygen saturation and indocyanin green plasma disappearance rate in postoperative cardio surgical patients. Eur. J. Anesthesiol. 2007; 24: 158.
  19. Jackman L., Shetty N., Davies P., Morris K.P. Lateonset hyperlactataemia following paediatric cardiac surgery. Intens. Care Med. J. 2009; 35 (3): 537–45.
  20. Ашихмина Е.А., Рыбка М.М., Лобачева Г.В., Гордеев С.Л., Чегрина Л.В. Гиперлактатацидемия в ближайшем послеоперационном периоде после операций на открытом сердце в условиях искусственного кровообращения: предиктор осложнений или артефакт? Медицинский альманах. 2015; 3: 108–13.
****
  1. Rybka M.M. Aspects of mods pathogenesis in cardiac surgery patients. Clinical Physiology of Circulation. 2016; 13 (2): 65–74 (in Russ.)
  2. Andersen L.W., Holmberg M.J., Doherty M., Khabbaz K., Lerner A., Berg K.M. et al. Postoperative lactate levels and hospital length of stay after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2015; 29 (6): 1454–60. DOI: 10.1053/j.jvca.2015.06.007
  3. Torshin V.A. Blood lactate level as an indicator of STAT analysis. Laboratory. 2001; 4: 17–9 (in Russ.)
  4. Fuller B.M., Dellinger R.P. Lactate as a hemodynamic marker in the critically ill. Curr. Opin. Crit. Care. 2012; 18 (3): 267–72. DOI: 10.1097/MCC.0b013e3283532b8a
  5. Kubiak G.M., Tomasik A.R., Bartus K. Lactate in cardiogenic shock – current understanding and clinical implications. J. Physiol. Pharmacol. 2018; 69 (1): 15–21. DOI: 10.26402/jpp.2018.1.02
  6. Laine G.A., Hu B.Y., Wang S., Solis T.R., Reul G.J. Jr. Isolated high lactate or low central venous oxygen saturation after cardiac surgery and association with outcome. J. Cardiothorac. Vasc. Anesth. 2013; 27 (6): 1271–6. DOI: 10.1053/j.jvca.2013.02.031
  7. Minton J., Sidebotham D.A. Hyperlactatemia and cardiac surgery. J. Extra Corpor. Technol. 2017; 49 (1): 7–15. 8. Fall P.J., Szerlip H.M. Lactic acidosis: from sour milk to septic shock. J. Intens. Care Med. 2005; 20 (5): 255–71. DOI: 10.1177/0885066605278644
  8. Vincent J.L., Quintairos E., Silva A., Couto L. Jr. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit. Care. 2016; 20 (1): 257. DOI: 10.1186/s13054-016-1403-5
  9. Lopez-Delgado J.C., Esteve F., Javierre C. Evaluation of serial arterial lactate levels as a predictor of hospital and long-term mortality in patients after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2015; 29 (6): 1441–53. DOI: 10.1053/j.jvca.2015.04.024
  10. Shinde S.B., Golam K.K., Kumar P., Patil N.D. Blood lactate levels during cardiopulmonary bypass for valvular heart surgery. Ann. Card. Anaesth. 2005; 8 (1): 39–44.
  11. Hajjar L.A., Almeida J.P., Fukushima J.T., Rhodes A., Vincent J.L., Osawa E.A. et al. High lactate levels are predictors of major complications after cardiac surgery. J. Thorac. Cardiovasc. Surg. 2013; 146 (2): 455–60. DOI: 10.1016/j.jtcvs.2013.02.003
  12. Lindsay A.J., Xu M., Sessler D.I., Blackstone E.H., Bashour C.A. Lactate clearance time and concentration linked to morbidity and death in cardiac surgicalpatients. Ann. Thorac. Surg. 2013; 95 (2): 486–92. DOI: 10.1016/j.athoracsur.2012.07.020
  13. Maillet J.M., Le Besnerais P., Cantoni M., Nataf P., Ruffenach A., Lessana A. et al. Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest. 2003; 123 (5): 1361–6. DOI: 10.1378/chest.123. 5.1361
  14. Jabbari A., Banihashem N., Alijanpour E., Vafaey H.R., Alereza H., Rabiee S.M. Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method. Caspian. J. Internal. Med. 2013; 4 (2): 662–6.
  15. Gjedsted J., Buhl M., Nielsen S., Schmitz O., Vestergaard E.T., Tonnesen E. et al. Effects of adrenaline on lactate, glucose, lipid and protein metabolism in the placebo controlled bilaterally perfused human leg. Acta Physiol. (Oxf). 2011; 202 (4): 641–8. DOI: 10.1111/j.1748-1716.2011.02316.x
  16. Badreldin A.M., Doerr F., Elsobky S., Brehm B.R., Abul-dahab M., Lehmann T. et al. Mortality prediction after cardiac surgery: blood lactate is indispensable. Thorac. Cardiovasc. Surg. 2013; 61 (8): 708–17. DOI: 10.1055/s-0032-1324796
  17. James J.H., Luchette F.A., McCarter F.D., Fischer J.E. Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet. 1999; 354 (9177): 505–8. DOI: 10.1016/S0140-6736(98)91132-1
  18. Thuemer O., Schelenz C., Sakka S. Changes in serum lactate, mix-venous oxygen saturation and indocyanin green plasma disappearance rate in postoperative cardio surgical patients. Eur. J. Anesthesiol. 2007; 24: 158.
  19. Jackman L., Shetty N., Davies P., Morris K.P. Lateonset hyperlactataemia following paediatric cardiac surgery. Intens. Care Med. J. 2009; 35 (3): 537–45.
  20. Ashikhmina E.A., Rybka M.M., Lobacheva G.V., Gordeev S.L., Chegrina L.V. Hyperlactatacidemia in the immediate postoperative period after open heart surgery in conditions of artificial blood circulation: predictor of complications or artifact? Medical Almanac. 2015; 3: 108–13 (in Russ.)

Об авторах

  • Юдин Геннадий Вячеславович, канд. мед. наук, врач – анестезиолог-реаниматолог; ORCID
  • Гончаров Андрей Андреевич, врач – анестезиолог-реаниматолог; ORCID
  • Рыбка Михаил Михайлович, доктор мед. наук, профессор, заведующий отделением анестезиологии-реанимации; ORCID
  • Дибин Денис Андреевич, врач – анестезиолог-реаниматолог; ORCID
  • Ломакин Максим Викторович, врач – анестезиолог-реаниматолог; ORCID
  • Хинчагов Джумбер Яковлевич, канд. мед. наук, врач – анестезиолог-реаниматолог; ORCID

 Если вы заметили опечатку, выделите текст и нажмите Alt+A