腹部大手术后首次动脉血乳酸浓度对患者并发症的预测价值  

Initial serum lactate level as predictor of morbidity after major abdominal surgery

作　　者：李声华[1] 刘芬[1] 张应天[2] 赵文辉[1] 

机构地区：[1]江汉大学附属医院麻醉科,武汉430015 [2]江汉大学附属医院普通外科 ,武汉430015

出　　处：《中华医学杂志》2008年第35期2470-2473,共4页National Medical Journal of China

摘　　要：目的探讨腹部大手术后动脉血乳酸浓度与术后并发症的关系。方法对139例腹部大手术患者收集如下资料：性别、年龄、术式、生理学和手术侵袭度评分（POSSUM）、术后24h内简化急性生理评分（SAPS）Ⅱ、术后早期首次实验室指标包括血红蛋白浓度、血肌酐、电解质、动脉血气指标pH、碱缺、PaO2／FiO2、乳酸浓度及术后各种并发症。比较术后有、无并发症的两组患者资料，采用多元Logistic回归分析独立预测术后并发症的因素。结果47例（34％）发生各种术后并发症。并发症组动脉乳酸值显著高于对照组（P〈0．01）。Logistic回归结果显示，乳酸水平（OR=1．81，95％CI：1．14～2．89，P〈0．05）和SAPSⅡ评分（OR=1．14，95％CI：1．08～1．21，P〈0．01）是预测术后并发症的两个独立因素。结论腹部大手术后首次动脉血乳酸水平与患者预后密切相关，可独立预测术后并发症。Objective To evaluate the value of immediate postoperative arterial lactate level to predict morbidity after major abdominal surgery. Methods 139 patients, 73 males and 66 females, aged （64 ± 14）（26- 87）, who underwent major abdominal surgery had their levels of arterial lactate, blood routine, blood gas and electrolytes measured after they were sent to the ICU. The physiological and operative severity score for the enumeration of mortality and morbidity （POSSUM） and the simplified acute physiology score Ⅱ （ SAPS Ⅱ） levels in the first 24-hour postoperative period were calculated Multivariate logistic regression analysis was utilized to examine the independent relationship of the initial lactate, blood gas values, and anion gap with the morbidity. Results Sixty-one cases of postoperative complications were recorded in the 47 patients （ 34% ）. The median initial lactate level of the patients with postoperative complications was 1.7 mmol/L, significantly higher than that of the patients without complication （ 1.2 mmol/L,P =0. 001 ）. Multivariate analysis showed that lactate level （odds ratio： 1.81, 95% confidence interval： 1.14 - 2. 89 ;P = 0. 013 ） and Simplified Acute Physiology Score Ⅱ（ SAPS Ⅱ （ odds ratio： 1.14 ; 95% confidence interval：1. 08 - 1.21 ,P 〈 0. 001 ） were significantly predictive of postoperative morbidity. The optimal value of lactate to discriminate between the patients who did or did not develop postoperative complications was 2. 7 mmol/L as associated with the highest sum of sensitivity and specificity （29. 8% and 95.7% respectively）. The lactate level more than 2. 7 mmol/L was associated with 9. 3-fold-higher odds for postoperative complications （95 % confidence interval： 2. 9 - 30. 4, P 〈 0. 001 ）. After adjustment for SAP Ⅱ, the lactate level 〉 2.7 mmol/L remained strongly associated with morbidity （odds ratio： 5.9; 95% confidence interval： 1.6 - 21.7 ; P = 0. 007 ） . Conclusion Initial serum lactate level is signif

关 键 词：乳酸 腹部 外科手术 手术后并发症 

分 类 号：R686[医药卫生—骨科学]