Okusawa S, Aikawa N, Abe O
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
Jpn J Surg. 1989 May;19(3):312-8. doi: 10.1007/BF02471407.
A prospective clinical study was performed on 293 patients, in order to elucidate the abnormalities in acid-base balance following general surgery. Six arterial blood gas and pH determinations were taken from each patient before surgery and on postoperative days zero, one, three, five and seven. A total of 1699 determinations were obtained. Although the majority of patients (87.5 per cent) had a normal acid-base balance before surgery, a postoperative metabolic alkalosis was seen in 50.5 per cent of the patients. However, there was an extremely low incidence of other postoperative acid-base abnormalities, apart from a transient increase in metabolic acidosis on the operative day. A significantly high mortality rate (32.3 per cent) was observed in 31 patients who had continuous metabolic alkalosis during the postoperative period. An excessive bicarbonate load resulting from the administration of fresh frozen plasma following surgery was strongly suggested as one of the major causes of postoperative metabolic alkalosis. Further investigation is required to elucidate the mechanism of the generation of metabolic alkalosis induced by the postoperative bicarbonate load in surgical patients.
对293例患者进行了一项前瞻性临床研究，以阐明普通外科手术后酸碱平衡的异常情况。在手术前以及术后第0天、第1天、第3天、第5天和第7天，对每位患者进行了六次动脉血气和pH测定。共获得1699次测定结果。尽管大多数患者（87.5%）在手术前酸碱平衡正常，但50.5%的患者术后出现了代谢性碱中毒。然而，除了手术当天代谢性酸中毒短暂增加外，其他术后酸碱异常的发生率极低。在术后期间持续存在代谢性碱中毒的31例患者中，观察到显著高的死亡率（32.3%）。强烈提示手术后输注新鲜冰冻血浆导致的碳酸氢盐负荷过多是术后代谢性碱中毒的主要原因之一。需要进一步研究以阐明手术患者术后碳酸氢盐负荷诱发代谢性碱中毒的发生机制。
