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Cardiopulmonary Bypass and Hyperlactataemie

Author: ZhangDong
Tutor: ZuoYinPing
School: Shanxi Medical
Course: Department of Cardiothoracic Surgery
Keywords: Cardiopulmonary bypass Lactic acid content Lactic acidosis Perioperative management Open heart surgery Hyperglycemia bypass Systemic inflammatory response Pyruvate Myocardial protection glucose Blood glucose levels operative Lactic acid synthesis Microcirculation SIRS Metabolic abnormalities A variety of mechanisms Artery Experimental study
CLC: R654.1
Type: Master's thesis
Year: 2010
Downloads: 77
Quote: 1
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Abstract


Background:In recent years, cardiac surgery under extracorporeal circulation has made great progress following the development of techniques of extracorporeal circulation. There is a great difference between extracorporeal circulation and physiological circulation. In extracorporeal circulation, metabolic abnormalities often occurs which induces microcirculation disturbance and the increasing of plasma lactic acid. As the specific product of anaerobic metabolism, plasma lactic acid content is one of the key indexes to assess the outcomes of cardiac surgery. Post-operative plasma lactate level is correlated with outcome after cardiac surgery in patients and is associated with the rate of post-operative adverse events and intensive care unit mortality. Therefore, it plays a significant role for the research of the mechanism of hyperlactacidemis as well as the reduction of the plasma lactic acid.Objective:To sum up the research advancement in the mechanism of hyperlactacidemia and how to reduce the plasma lactic acid content.Retrieval strategy:The relevant articles published between July 1979 and March 2010 were searched in Springer database by researcher of the article with the key words of "Lactic acid, bypass' dissertation">Cardiopulmonary bypass" or " SIRS, Blood glucose" in English.356 articles were selected and reviewed by the inclusive criteria of:①articles closely related with the mechanism of hyperlactacidemia and how to reduce the lactic acid content.②the articles are published recently in authority journals in the same field.Literature evaluation:The main sources of literatures are from topic of the randomized clinical trial (RCT) on the mechanism of hyperlactacidemia and how to reduce the lactic acid content. Among 59 selected articles,2 are reviews, the others are elementary experimental studies.Data synthesis:①Lactate is the final product of anaerobic glycolytic breakdown of glucose. Lactate is generated by the reaction of pyruvate with NADH, as a consequence of anaerobic glycolytic breakdown of glucose to pyruvate during the oxygen-limited energy depletion.②The mechanism of hyperlactacidemia contributed to inflammatory reaction during extracorporeal circulation, Hyperglycaemia after cardic surgery with extracorporeal circulation and using drugs in perioperative period, etc.③There are several ways which reduce lactic acid content postoperative, Such as inhibition inflammatory reaction after operation, controlling blood glucose level, minimizing use of perioperative drugs, organs-protective therapy, retrieving acid-base imbalances actively, etc.Conclusion:There are many kinds of mechanisms which increase production of plasma lactic acid after cardiac surgery during extracorporeal circulation. The concentration of lactic acid in patients decreases obviously after many kinds of methods.

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CLC: > Medicine, health > Surgery > Of surgery > Cardiovascular and lymphatic system surgery > Cardiopulmonary bypass and resuscitation
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