中国体外生命支持2026，Vol.24Issue(4)：284-291,320,9.DOI:10.13498/j.cnki.chin.j.ecls.2026.04.04
体外循环期间时间加权平均动脉压与急性A型主动脉夹层术后高乳酸血症的关联研究
Association Between Time-Weighted Average Mean Arterial Pressure During Cardiopulmonary Bypass and Postoperative Hyperlactatemia After Acute Type A Aortic Dissection Surgery
摘要
Abstract
Objective To investigate whether a time-weighted average mean arterial pressure(TWA-MAP)<65 mmHg during cardiopulmonary bypass(CPB)is associated with an increased risk of postoperative hyperlactatemia(POHL)in patients undergoing emergency surgical repair of acute type A aortic dissection(ATAAD).Methods Patients with ATAAD who under-went emergency surgical repair with CPB at the First Hospital of China Medical University from May 1,2022 to December 31,2025 were enrolled.After propensity score matching,51 patients with a TWA-MAP<65 mmHg were assigned to the low-MAP(L-MAP)group,and 51 patients with a TWA-MAP≥65 mmHg were assigned to the high-MAP(H-MAP)group.Blood lactic acid levels were monitored before surgery(T0),at the end of CPB(T1),at the end of surgery(T2),and at 1 h(T3),6 h(T4)and 24 h(T5)after surgery.The primary outcomes were the change in postoperative blood lactate level and the incidence of POHL.Results Repeated measures analysis of variance showed significant differences in blood lactic acid levels among groups,across time points,and in the group-by-time interaction(all P<0.001).Blood lactic acid in the H-MAP group was significantly lower than that in the L-MAP group at T2,T3 and T4(P<0.001).The incidence of POHL in the H-MAP group was significantly lower than that in the L-MAP group(P=0.004).Compared with L-MAP group,the extubation time,length of ICU stay and length of hospital stay in H-MAP group were significantly shortened(P<0.05).Conclusion In patients undergoing emergency surgical repair of ATAAD with CPB,intraoperative TWA-MAP<65 mmHg is associated with more significant fluctuations in blood lac-tate level and increased risk of POHL after surgery.关键词
急性A型主动脉夹层/体外循环/时间加权平均动脉压/术后高乳酸血症/倾向性评分匹配/灌注管理Key words
acute type A aortic dissection/cardiopulmonary bypass/time-weighted average mean arterial pressure/post-operative hyperlactatemia/propensity score matching/perfusion management引用本文复制引用
王宇星,郭禹含,韩英,张静..体外循环期间时间加权平均动脉压与急性A型主动脉夹层术后高乳酸血症的关联研究[J].中国体外生命支持,2026,24(4):284-291,320,9.基金项目
中华医学会医学教育分会和中国高等教育学会医学教育专业委员会2018年医学教育研究课题(2018B-N18028) （2018B-N18028）
