中国体外生命支持2026，Vol.24Issue(4)：292-300,9.DOI:10.13498/j.cnki.chin.j.ecls.2026.04.05
氧供指数与心脏指数对心脏瓣膜术后高乳酸血症的预测效能比较
Comparison of the Predictive Efficacy of Oxygen Delivery Index and Cardiac Index for Hyperlactatemia After Cardiac Valve Surgery
摘要
Abstract
Objective To compare the predictive effectiveness of oxygen delivery index(DO2I)and cardiac index(CI)for hyperlactatemia after cardiopulmonary bypass(CPB)in patients undergoing heart valve surgery,and to explore the clinical necessity of combined DO2I monitoring on the basis of conventional flow monitoring.Methods A total of 106 patients who underwent elective heart valve surgery in our hospital from January 2023 to January 2025 were retrospectively included.Hyper-lactatemia was defined as peak blood lactate≥3.0 mmol/L 24 hours after surgery,and patients were divided into an observation group of 50 cases and a control group of 56 cases.Perioperative hemodynamics,oxygen metabolism,and postoperative prognos-tic indicators were compared between the two groups;partial correlation analysis corrected for CPB duration and aortic cross-clamp time was used to explore the association between intraoperative perfusion parameters and postoperative lactate levels;considering the mathematical collinearity of DO2I and CI,separate multivariate logistic regression models were constructed.The regression model was used to screen independent risk factors for hyperlactatemia;internally-validated receiver operating charac-teristic(ROC)curve based on 500-bootstrap resampling was used in combination with the DeLong test to compare the predictive efficacy of the two,and the reliability of the lactate cutoff value was verified through lactate quartile stratification and restricted cubic spline(RCS)analysis.Results The average DO2I,lowest DO2I,lowest CI,and lowest mixed venous blood oxygen sat-uration during CPB in the observation group were lower than those in the control group,and the average intraoperative blood sugar was higher(all P<0.05).After adjusting for confounding factors,the negative correlation strength between the lowest DO2I and postoperative peak lactate(r=-0.523)was higher than that of the lowest CI(r=-0.458).Multivariate regression showed that after adjusting for baseline and intraoperative confounding variables,the lowest DO2I(OR=0.985,P=0.017)and the lowest CI(OR=0.451,P=0.003)were independent protective factors for postoperative hyperlactatemia.Bootstrap-adjusted ROC results showed that the area under the curve(AUC)of the lowest DO2I in predicting postoperative hyperlactatemia was 0.743,and the optimal cutoff value was 272 mL/(min·m2).The predictive performance was significantly better than the lowest CI(AUC=0.623,P=0.031).The AUC of the DO2I combined CI model was 0.771,with no statistical gain compared with DO2I alone(P>0.05).Lactate stratification and RCS analysis confirmed that 3.0 mmol/L is the inflection point of lactic acid risk,and there is a stable dose-response negative correlation between DO2I and postoperative lactate.The incidence of postoperative acute kidney injury,duration of mechanical ventilation,length of intensive care unit stay and vasoactive drug score in the observation group were significantly higher than those in the control group(all P<0.01).Conclusion The lowest DO2I during CPB surgery is a reliable independent predictor of postoperative hyperlactatemia in patients undergoing valve surgery,and its predictive performance is better than CI.A cutoff value of 272 mL/(min·m2)can be used as an intraoperative warning threshold.Simple CI monitoring has obvious limitations,and routine intraoperative monitoring of DO2I has clear clinical necessity,which can provide a reference for goal-oriented cardiopulmonary bypass perfusion management in valve surgery.关键词
体外循环/氧供指数/心脏指数/高乳酸血症/心脏瓣膜手术/目标导向灌注Key words
cardiopulmonary bypass/oxygen delivery index/cardiac index/hyperlactatemia/heart valve surgery/goal-di-rected perfusion引用本文复制引用
闫振,赵培新,叶尔买克·唐沙哈尔,阿依别克·乃比,郭永忠,隋丰光,余波锋..氧供指数与心脏指数对心脏瓣膜术后高乳酸血症的预测效能比较[J].中国体外生命支持,2026,24(4):292-300,9.基金项目
新疆战略人才培养计划一流科技领军人才项目(XJRC-2025-KJ-PY-KJLJ-115) （XJRC-2025-KJ-PY-KJLJ-115）
