Brinkmann A, Seeling W, Rockemann M, Junge J H, Radermacher P, Wiedeck H, Büchler M W, Georgieff M
Department of Anesthesiology, University Clinics, Ulm, Germany.
Dig Surg. 1999;16(2):117-24. doi: 10.1159/000018703.
BACKGROUND/AIM: During major abdominal surgery, mesenteric traction (MT) may result in hemodynamic instability mainly due to endogenous prostacyclin release. Gastric intramucosal pH (pHi) and PiCO2 are indicators of splanchnic tissue perfusion with a predictive value for the postoperative outcome. We investigated the influence of MT on gastric pHi and on postoperative outcome in patients undergoing pancreas surgery.
Forty-six consecutive patients scheduled for pancreas surgery were investigated. We registered hemodynamics and pHi by gastric tonometry and documented postoperative outcome (complications, hospital stay). Baseline data (T0) were recorded after skin incision. Further assessments followed 30, 60 and 120 min after intentional MT (T1-3) and at the end of surgery (T4).
Thirty-three patients demonstrated a decrease in mean arterial pressure (MAP) following MT, whereas 13 patients showed entirely stable hemodynamics. The significant reduction in MAP in patients with an MT response was not associated with changes in pHi as compared to patients with no response (stable MAP) (T0 7.34 +/- 0.08 vs. 7.35 +/- 0.06; T1 7.34 +/- 0.05 vs. 7.32 +/- 0.07; T2 7.32 +/- 0. 05 vs. 7.31 +/- 0.08; T3 7.32 +/- 0.05 vs. 7.32 +/- 0.07; T4 7.26 +/- 0.1 vs. 7.27 +/- 0.08; mean +/- SD, MT response vs. no response). Neither MT response nor gastric intramucosal acidosis as evidenced by a pHi <7.32 at the end of surgery predicted postoperative complications or longer hospital stay.
No deterioration of gastric pHi was found, which could reflect acceptable splanchnic perfusion and oxygenation despite systemic blood pressure reactions in patients experiencing an MT response.
背景/目的：在腹部大手术期间，肠系膜牵拉（MT）可能主要由于内源性前列环素释放而导致血流动力学不稳定。胃黏膜内pH值（pHi）和动脉血二氧化碳分压（PiCO2）是内脏组织灌注的指标，对术后结局具有预测价值。我们研究了MT对胰腺手术患者胃pHi及术后结局的影响。
对46例计划进行胰腺手术的连续患者进行研究。我们通过胃张力测定法记录血流动力学和pHi，并记录术后结局（并发症、住院时间）。皮肤切开后记录基线数据（T0）。在有意进行MT后30、60和120分钟（T1 - 3）以及手术结束时（T4）进行进一步评估。
33例患者在MT后平均动脉压（MAP）下降，而13例患者血流动力学完全稳定。与无反应（稳定MAP）的患者相比，有MT反应的患者MAP显著降低与pHi变化无关（T0 7.34±0.08 vs. 7.35±0.06；T1 7.34±0.05 vs. 7.32±0.07；T2 7.32±0.05 vs. 7.31±0.08；T3 7.32±0.05 vs. 7.32±0.07；T4 7.26±0.1 vs. 7.27±0.08；均值±标准差，MT反应组与无反应组）。手术结束时pHi<7.32所证明的MT反应或胃黏膜内酸中毒均不能预测术后并发症或更长的住院时间。
未发现胃pHi恶化，这可能反映出尽管有MT反应的患者出现全身血压反应，但内脏灌注和氧合仍可接受。
