限制容量下肝脏部分切除病人围手术期处理对血乳酸值和乳酸清除率影响研究

Effect of perioperation care on serum arterial lactate value and lactate clearance rate in patients undergoing partial hepatectomy under fluid restriction

目的研究肝部分切除病人在肝脏病灶切除前限制液体输注、围手术期处理对动脉血乳酸值的影响因素。方法选择2017年6-12月北京大学肿瘤医院行开腹肝脏部分切除的美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级病人为研究对象,肝脏病灶切除前限制液体输注速度为6 m L/(kg·h)。肝脏病灶切除后加快输液速度。测定围手术期动脉血乳酸值,计算血乳酸清除率。结果 67例病人中,肝脏病灶切除后10 min(T3)和出恢复室前(T4)血乳酸值明显增高。T3和T4血乳酸值与肝门阻断时间有显著正相关性(P<0.001)。各时间点血乳酸值与给麻黄碱次数、快速补液次数、出血量、肝脏切除期间中心静脉压(CVP)均值以及是否存在肝硬化无相关性。血乳酸清除率均值为正值。结论肝门阻断可增加血乳酸值。病灶切除后加快输液可维持血乳酸清除率为正值。

Objective To investigate the related factors of serum arterial lactate concentration in hepatectomy patients with fluid restriction before resection of liver lesions. Methods Patients classified as ASA I or II who had been chosen for an open procedure were candidated for elective liver resections at our hospital between Jun 2017 and Dec 2017. Limited fluid was infused at rate 6 mL/（kg·h） before liver resection. The infusion speed was quickened after resection of liver lesion. Patients＇ demographic data, portal triad clamping period were recorded. All serum arterial lactate concentration were measured by arterial blood gas analysis during perioperation. Results In 67 patients, the blood lactate value increased significantly at 10 minutes after the end of resection of the liver lesion （T3）and T4 at end of leaving recovery room（T4）.There was significant positive correlation between the lactate value at T3 and T4 the duration of portal triad clamping （P〈O.O01）. There was no significant correlation between the lactate value during perioperation and the number of ephedrine, the number of rapid fluid bolus, the amount of blood loss, the value of CVP during hepatectomy and liver eirrhosis. Conclusion Hepatic portal elamping increases the value of arterial blood laetate in patients with undergoing hepatectomy. The blood lactate clearanee rate is positive while liquid infusion is accelerated after liver resection.