乳酸指导性治疗改善心脏术后患者的预后.pdfVIP

第15卷第1期 中国医学工程 V01．15 No．1 2007年 1月 China Medical Engineering Jan．2007 文章编号： 1672—2019(2007)Ol一0016—03 · 论著· 乳酸指导性治疗改善心脏术后患者的预后 李政霖，李元忠，郭玉梅 (大连市中心医院，辽宁 大连 儿6033) 摘要：目的 对于心脏术后的患者给予连续监测血乳酸，并根据血乳酸水平调整治疗方案，以确定这种方 法是否能改善患者的预后。方法 对于连续收治的82名心脏术后患者分成两组，这两组除了一组测定乳酸水 平其他治疗相同。观察死亡率、肺内感染的发生率、上呼吸机时间、住院时间等指标。以评估乳酸指导性治疗是 否能改善心脏术后患者的预后。结果 乳酸指导性治疗可以明显改善心脏患者的死亡率，住院时间。结论 使 用血乳酸水平可以更好地监测患者组织水平的灌注是否充分，结合使用中心静脉压对于补液及心功能的调整 比单独使用中心静脉压更有优势，能很好地改善患者的预后。 关键词：血乳酸；中心静脉压；心脏术后；死亡率； 中图分类号： R654．1 文献标识码：A Lactate-directed medical therapy improves outcomes after heart surgery LI Zheng—lin，LI Yuan—zhong，GUO Yu-mei (Ddi~Central Hospital,Dalian,Liaoning 116033,P．R．China) Abstract：【Objective】To reduce the mortality of patients after heart surgery with a goal-directed therapy algo- rithm．【Methods】Prospective study of patients undergoing surgery utilizing a goal-directed therapy algorithm in the postoperative period．The results of this group were compared with a historical cohort．Patients undergoing surgery from July 2003 through October 2005 were compared with cohorts from June 2001 through June 2003 in a 15一bed general intensive care unit of a general hospita1．Beginning in July 2003，blood lactate measurements were performed serially for 24 h after heart surgery Based on lactate values and trends ， therapy was amended．【Results】Mortality was lowerfor group A．The recovery time duration of normal blood pressure and urine volume Was sooner in G