摘要
目的 分析肝切除术中入肝血流阻断对术后动脉血乳酸水平及pH值的影响.方法 回顾性分析我科2006年1月至2008年12月行肝切除术的68例患者,根据术中是否行人肝血流阻断分为肝门阻断组（20例）、规则半肝切除组（22例）和未阻断肝门组（26例）.比较3组患者术后动脉血气、乳酸浓度及肝、肾功能等指标.结果 肝门阻断组和规则半肝切除组患者术后动脉血乳酸浓度明显升高[（5.53±2.31）mmoL/L,（5.62±2.52）mmol/L）,与术中未阻断肝门组[（3.37±1.56）mmol/L]比较差异均有统计学意义（P〈0.05）;半肝切除组HCO3^-水平较肝门不阻断组明显降低[（19.68±3.82）mmoL/L vs（21.65±2.48）mmol/L,P〈0.05];3组患者术后的pH、肝肾功能等改变无统计学意义.结论 人肝血流阻断可导致肝切除术后动脉血乳酸水平明显增高,术后密切监测乳酸浓度并及时处理,可避免术后高乳酸血症及代谢性酸中毒.
Objective To investigate the impact of vascular inflow occlusion of the liver on arterial lactate level and pH value. Methods In this study, 68 patients who underwent hepatectomy from January 2006 to December 2008 were retrospectively studied. The patients were assigned to one of the three study groups according the vascular inflow status： clamping of portal vein and hepatic artery in the hepatic pedicle （n = 20）, hemihepatectomy under total hemihepatic vascular exclusion （THVE, n = 22）, and non-vascular occlusion （n = 26）. Postoperative arterial blood gas analysis including systemic arterial lactate concentration, and liver and renal function tests were performed. Results Systemic arterial blood lactate levels significantly elevated in the portal clamping and THVE groups （5.53 ±2. 31 mmol/L and 5.62 ±2.52mmol/L, respectively）, compared to the non-occlusion group （3. 37 ± 1.56 mmol/L, P 〈 0. 05） ;significant increase in arterial HCO3^- level was observed in the THVE group in comparison to the nonocclusion group （19. 68 ± 3. 82） mmol/L vs. （21.65 ± 2. 48） mmol/L, （P 〈 0. 05）. There were no significant differences as to the changes of pH values, liver and renal function tests between the three groups. Conclusions Vascular inflow deprivation may result in significantly increased arterial lactate level. Thus, intense surveillance of blood lactate level with prompt treatment is necessary to prevent postoperative hyperlactatemia and metabolic acidosis.
出处
《中华普通外科杂志》
CSCD
北大核心
2010年第5期373-376,共4页
Chinese Journal of General Surgery
基金
美国China Medical Board of New York基金资助项目（CMB 06-837）
关键词
肝切除术
乳酸
高乳酸血症
入肝血流阻断
Hepatectomy
Lactic acid
Hyperlactatemia
Vascular inflow occlusion of the liver
