Poeze M, Takala J, Greve J W, Ramsay G
Department of Surgery, University Hospital Maastricht, The Netherlands.
Intensive Care Med. 2000 Sep;26(9):1272-81. doi: 10.1007/s001340000604.
To determine whether a) pre-operative measurement of gastric intramucosal pHi is predictive for mortality and morbidity in high-risk surgical patients and b) peri-operative improvement of global oxygen delivery (DO2) with fluids and dopexamine leads to increased gastric pHi and c) either improved global perfusion or improved splanchnic perfusion is related to the prevention of multiple organ failure (MOF).
Retrospective analysis of a double-blind, placebo-controlled, randomised study.
General intensive care units from 14 hospitals.
Two hundred eighty-six high-risk surgical patients.
Swan-Ganz and tonometer catheter placement; patients were stabilised pre-operatively using fluids, blood and/or oxygen to preset goals before receiving placebo or two doses of dopexamine (0.5 or 2.0 microg.kg.min) peri-operatively.
Haemodynamic assessment (including DO2 and oxygen consumption (VO2)) was performed together with measurement of gastric mucosal pHi pre-operatively and directly, 2, 6, 12, 24 and 36 h post-operatively. Retrospectively, patients were divided pre-operatively into two sub-groups based on the optimal cut-off value for mortality of the first pHi measurement after induction of anaesthesia as calculated by a receiver operator characteristic (ROC) curve analysis --low pHi group (< 7.35) and normal pHi (> or =7.35). Mortality in the low pHi, was higher than in the normal pHi, group (16.8 vs 2.3%; p = 0.0001). In the normal pHi group dopexamine, which was given prior to the first pHi measurement, had no effect on pHi, while DO2 increased significantly. In this group MOF score and number of patients with MOF remained similar for the treatment sub-groups. In the low pHi group gastric pHi increased significantly during dopexamine infusion (p = 0.008), despite the lack of an increase in DO2 and VO2. In this group the MOF score and the number of patients developing MOF decreased significantly with the use of dopexamine (p = 0.04). In both groups bicarbonate levels remained similar for the treatment subgroups.
In high-risk surgical patients pre-operative measurement of pHi was predictive for mortality. The peri-operative response of pHi to dopexamine seemed to be dependent on pre-operative gastric pHi.
确定a）术前测量胃黏膜内pH值是否可预测高危手术患者的死亡率和发病率；b）围手术期通过补液和多培沙明改善全身氧输送（DO2）是否会导致胃pH值升高；c）全身灌注改善或内脏灌注改善是否与预防多器官功能衰竭（MOF）相关。
对一项双盲、安慰剂对照、随机研究进行回顾性分析。
14家医院的普通重症监护病房。
286例高危手术患者。
放置Swan-Ganz导管和胃张力计导管；术前通过补液、输血和/或给氧使患者稳定至预设目标，然后在围手术期给予安慰剂或两剂多培沙明（0.5或2.0μg·kg-1·min）。
进行血流动力学评估（包括DO2和氧耗量（VO2）），并在术前及术后2、6、12、24和36小时直接测量胃黏膜pH值。回顾性地，根据麻醉诱导后首次pH值测量的死亡率最佳截断值，通过受试者工作特征（ROC）曲线分析将患者术前分为两个亚组——低pH值组（<7.35）和正常pH值组（≥7.35）。低pH值组的死亡率高于正常pH值组（16.8%对2.3%；p = 0.0001）。在正常pH值组中，在首次pH值测量前给予的多培沙明对pH值无影响，而DO2显著增加。该组中治疗亚组的MOF评分和发生MOF的患者数量保持相似。在低pH值组中，尽管DO2和VO2没有增加，但在输注多培沙明期间胃pH值显著升高（p = 0.008）。在该组中，使用多培沙明后MOF评分和发生MOF的患者数量显著降低（p = 0.04）。两组中治疗亚组的碳酸氢盐水平保持相似。
在高危手术患者中，术前测量pH值可预测死亡率。pH值对多培沙明的围手术期反应似乎取决于术前胃pH值。
