肠道手术和骨科手术围术期胃粘膜pH值及其相关因素的变化  

A comparative study on the changes of gastric mucosal pH and plasma lactate during colorectal and orthopaedic surgical procedures

作　　者：洪溪[1] 叶铁虎[1] 黄宇光[1] 任洪智[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院麻醉科,北京市100730

出　　处：《临床麻醉学杂志》2006年第4期263-265,共3页Journal of Clinical Anesthesiology

摘　　要：目的本研究观察了不同手术围术期胃粘膜pH值(ipH)和血浆乳酸浓度的变化,探讨ipH作为反映微循环状态指标的灵敏性。方法随机选择全麻下行椎管手术(Ⅰ组)和直肠结肠癌根治术(Ⅱ组)的病人各10例,测定术前、手术开始(切皮)后2、4和6h的ipH和血浆乳酸浓度,同时记录心率、血压、失血量等常规指标。结果两组的ipH自手术开始后均逐渐降低,切皮后4h达最低点,与手术时间长短呈弱负相关(r=-0.505),而Ⅱ组比Ⅰ组降低更明显(P<0.05);血浆乳酸浓度随手术进行呈升高趋势,其变化迟于ipH。结论ipH可较早和更灵敏地反映组织灌流和微循环的障碍,比乳酸更灵敏;肠道手术比骨科手术对ipH的影响更明显,可能与肠道手术操作对肠粘膜屏障的损伤以及术前禁食过长有关。Objective To investigate the perioperative changes of gastric mucosal pH （i-pH） value and plasma lactate, for evaluating the sensitivity of i-pH as a marker of microcirculation. Methods Ten patients underlying spine surgery （group Ⅰ ） or colorectal surgery （group Ⅱ ） were selected, i-pH and plasma lactate were measured before operation, at 2, 4 and 6 h after skin incision. Clinical signs such as blood pressure （BP）, heart rate （HR） as well as blood loss were also recorded simultaneously. Results Under similar clinical enviroment, i-pH decreased gradually after skin incision in both groups, with the nadir at 4 h after incision, which was negatively correlated with the duration of operation （r=-0. 505）. While i-pH decreased more significantly in group Ⅱ than that in group Ⅰ （P〈0.05）. Plasma lactate elevated along with the operation, but later than i-pH. Conclusion i-pH is more sensitive than plasma lactate in reflecting tissue perfusion and microcirculation impairment. Colorectal surgery may induce further interference with the homeostasis than the spine surgery, possibly due to the prolonged fasting state and impairment of intestinal mucoaa barrier caused by surgical manipulation.

关 键 词：胃粘膜pH值(i-pH) 乳酸 肠道手术 骨科手术 

分 类 号：R614[医药卫生—麻醉学]