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目的:探讨成人心脏术后难治性低心排血量综合征(PCCS)启动体外膜肺氧合辅助(VA-ECMO)时乳酸水平对患者临床预后的影响。方法:回顾性分析2004年1月至2017年12月间144例成人PCCS行VA-ECMO辅助的患者临床资料。按照安装ECMO时乳酸水平分为两组：低乳酸组(54例)和高乳酸组(90例)。比较两组患者VA-ECMO辅助情况和临床预后。结果:144例中92例(63.9%)成功撤机，52例(36.1%)生存出院。与低乳酸组患者比较，高乳酸组启动VA-ECMO辅助时血管活性药物指数(48.2±9.7对24.6±8.5)和序贯器官衰竭评分(12.2±2.9对9.6±2.1)较高，VA-ECMO辅助期间肾脏功能衰竭需持续性血液透析治疗较多(68.9%对35.2%)，成功撤机率(53.3%对81.5%)和出院生存率(68.5%对16.7%)，差异均有统计学意义(n P<0.05)。多元回归分析结果显示，ECMO启动时高乳酸水平是影响患者临床预后的独立风险因素(比值比11.9，95%置信区间2.9～48.0，n P8.6 mmol/L)较高的患者临床预后较差。乳酸水平有助于判断成人PCCS患者启动VA-ECMO辅助的时机。“,”Objective:To investigate the relationship between serum lactate before initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and in-hospital mortality in adult patients with postcardiotomy refractory cardiogenic shock (PCCS).Methods:We analyzed 144 consecutive adult patients with PCCS received VA-ECMO support between January 2004 and December 2017. Patients were divided into two groups according to the serum lactate level before initiation of xVA-ECMO: low lactate group (LG, 54 cases) and high lactate group (HG, 90 cases). VA-ECMO support parameters and clinical outcomes were compared between the two groups.Results:92 (63.9%) patients were successfully weaned off VA-ECMO, and 52 (36.1%) were discharged. The inotrope scores, sequential organ failure assessment (SOFA) score at VA-ECMO initiation, and renal failure requiring renal replacement therapy during VA-ECMO support in patients with high lactate level were statistically higher (n P<0.05). The successfully wean off VA-ECMO (53.3% vs. 81.5%) and survival to discharge (16.7% vs. 68.5%) was significantly lower among patients in the HG group (n P<0.05). In multivariate analysis, high lactate levels before initiation of VA-ECMO remained the independent predictor of survival (odds ratio 11.9, 95% confidence interval 2.9-48.0,n P8.6 mmol/L) before initiation of VA-ECMO is independently related to in-hospital mortality in adult patients with delayed refractory PCCS. This found may help clinicians to use VA-ECMO more effectively for those patients.