胰腺手术后乳酸升高的频率及其与术后并发症的关系

IF 0.8 Q4 SURGERY
Lana Othman Mahmmud , Vilhelmas Bartusevicius , Åke Norberg , Poya Ghorbani , Jonathan Grip
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引用次数: 0

摘要

背景:大胰腺手术后乳酸水平经常升高,但其临床意义尚不清楚。方法对491例连续行胰腺大手术患者进行回顾性研究。检测到达麻醉后单位时(L0)、术后早晨(LPOD1)及这两个时间点内的最高值(LHigh)。主要结局是术后并发症(Clavien-Dindo IIIa-V),次要结局是手术特异性并发症和住院时间。结果乳酸中位数为:L01.7 mmol/L (IQR: 1.2 ~ 2.6), LPOD11.3 mmol/L (IQR: 0.9 ~ 1.9), LHigh 2.3 mmol/L (IQR: 1.7 ~ 3.1)。在发生并发症的患者和没有发生并发症的患者之间,在任何测量点的乳酸值都没有差异。AUROC分析(0.531-0.581)和Youden指数(0.08-0.17)显示诊断效果较差。LHigh祝辞2.65 mmol/L与术后并发症的比值比为2.05(1.34 -3.14)。在所有三个时间点,全胰切除术后血浆乳酸水平均高于部分切除术。胰腺手术后血浆乳酸水平升高的探讨然而,这在预测并发症方面的临床应用有限。全胰切除术后相对较高的乳酸可能是由于该手术固有的激素缺陷。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Frequency of lactate elevation following pancreatic surgery and its relationship to postoperative complications

Frequency of lactate elevation following pancreatic surgery and its relationship to postoperative complications

Background

Lactate is often elevated following major pancreatic surgery but the clinical relevance of this it not known.

Methods

A retrospective study including 491 consecutive patients undergoing major pancreatic surgery. Lactate upon arrival to post anaesthesia unit (L0), the morning following surgery (LPOD1) and the highest value within those two time points (LHigh) were examined. The primary outcome was postoperative complications (Clavien-Dindo IIIa-V) and the secondary outcomes were surgery specific complications and hospital length of stay.

Results

Median lactate values were: L01.7 mmol/L (IQR: 1.2 –2.6), LPOD11.3 mmol/L (IQR: 0.9 –1.9) and LHigh 2.3 mmol/L (IQR 1.7 –3.1). There were no differences in lactate values at any measuring point between those developing complications and those that didn´t. AUROC analysis (0.531–0.581) and Youden´s index (0.08–0.17) indicated poor diagnostic performance. LHigh > 2.65 mmol/L was associated with Odds ratio 2.05 (1.34 –3.14) for developing postoperative complications. Plasma lactate was higher following total pancreatectomy compared to partial resection at all three time points.

Discussion

Plasma lactate elevation in common following pancreatic surgery; however, this is of limited clinical use to predict complications. The relatively higher lactate following total pancreatectomy might be due to hormonal deficits inherent to this procedure.
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CiteScore
0.80
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38 days
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