Hörer Tal M, Norgren Lars, Jansson Kjell
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Scand J Gastroenterol. 2011 Jul;46(7-8):913-9. doi: 10.3109/00365521.2011.568519. Epub 2011 Mar 28.
We have previously presented microdialysis findings of early intraperitoneal (i.p.) metabolic disturbances, mainly an increased lactate/pyruvate (l/p) ratio, in surgical patients developing postoperative complications. The aim of the present study was to investigate i.p. glycerol and l/p ratio after major surgery with and without complications.
Sixty patients were followed with microdialysis for 48 h after major abdominal surgery, 44 patients without postoperative complications and 16 patients with major surgical complications. Intraperitoneal and subcutaneous (s.c.) measurements of glycerol, lactate, pyruvate and glucose were performed, and the l/p ratio was calculated.
Intraperitoneal glycerol was significantly lower in the complication group compared with the control group (64 vs. 94.6 μM; p = 0.0015), while the i.p. l/p ratio was significantly higher in the complication group compared with the control group (13.7 vs. 11.1; p = 0.0073).
In this study, i.p. glycerol levels were lower and i.p. l/p ratio was higher in the immediate postoperative period in a group of patients with complications. These results might indicate early i.p. disturbances in fat and carbohydrate metabolism in patients who later developed symptoms of postoperative major complications.
我们之前曾报道过，在出现术后并发症的外科手术患者中，通过微透析发现早期腹膜内（i.p.）存在代谢紊乱，主要表现为乳酸/丙酮酸（l/p）比值升高。本研究的目的是调查大手术后有并发症和无并发症患者的腹膜内甘油和l/p比值情况。
60例患者在接受腹部大手术后接受了48小时的微透析监测，其中44例患者无术后并发症，16例患者出现了严重手术并发症。对腹膜内和皮下（s.c.）的甘油、乳酸、丙酮酸和葡萄糖进行了测量，并计算了l/p比值。
与对照组相比，并发症组的腹膜内甘油水平显著降低（64对94.6 μM；p = 0.0015），而并发症组的腹膜内l/p比值显著高于对照组（13.7对11.1；p = 0.0073）。
在本研究中，一组有并发症的患者在术后即刻腹膜内甘油水平较低，腹膜内l/p比值较高。这些结果可能表明，后期出现术后严重并发症症状的患者早期存在腹膜内脂肪和碳水化合物代谢紊乱。
