Jipa Lavinia-Nicoleta, Tomescu Dana, Droc Gabriela
Department of Anaesthesiology and Intensive Care I, Fundeni Clinical Institute, Bucharest, Romania.
Department of Anaesthesiology and Intensive Care III, Fundeni Clinical Institute, Bucharest, Romania.
Rom J Anaesth Intensive Care. 2014 Oct;21(2):106-112.
The aim of this study was to determine whether arterial blood lactate concentration at the end of liver transplantation is associated with major postoperative complications, length of Intensive Care Unit (ICU) stay and mortality.
Arterial lactate concentration was recorded at the end of surgery in 48 patients (30 males and 18 females) who had underwent liver transplantation (LT) over a six month period between June 2013 and December 2013. Demographic data, laboratory results and postoperative outcome were recorded.
The mean age in the study group was 51.14 years (16-62); all the patients had undergone deceased-donor liver transplantation. The etiology of liver disease was various: viral infections (HBV and HCV), alcoholic cirrhosis, hepatocarcinoma and other rare causes of cirrhosis (Wilson disease) were found. The mean duration of surgery was 407 minutes (240-580). Mean lactate was 2.77 mmol/L (0.8-7.9) and was increased above 1.5 mmol/L in 33 (68.75%) patients. ICU length of stay was longer in patients having lactate levels > 5 mmol/L (p = 0.05). Intraoperative blood loss was higher in patients with lactate > 3 mmol/L (p = 0.012). Major complications including acute kidney injury, need for emergency surgery during ICU stay or primary graft disfunction were observed only in patients with lactate levels > 1.5 mmol/L (18.2%). Sixty days mortality was 100% in the group with lactate > 5 mmol/L (4 patients) compared with 12.5% mortality in patients with lactate level < 5 mmol/L (p = 0.05).
Arterial lactate concentrations at the end of liver transplantation correlates with increased intraoperative blood loss, longer ICU stay, and increased mortality.
本研究旨在确定肝移植结束时动脉血乳酸浓度是否与术后主要并发症、重症监护病房（ICU）住院时间及死亡率相关。
记录了2013年6月至2013年12月这六个月期间接受肝移植（LT）的48例患者（30例男性和18例女性）手术结束时的动脉乳酸浓度。记录了人口统计学数据、实验室检查结果及术后结局。
研究组的平均年龄为51.14岁（16 - 62岁）；所有患者均接受了尸体供肝肝移植。肝病病因多样：发现有病毒感染（乙肝和丙肝）、酒精性肝硬化、肝癌及其他罕见的肝硬化病因（威尔逊病）。平均手术时间为407分钟（240 - 580分钟）。平均乳酸水平为2.77 mmol/L（0.8 - 7.9），33例（68.75%）患者的乳酸水平高于1.5 mmol/L。乳酸水平>5 mmol/L的患者ICU住院时间更长（p = 0.05）。乳酸>3 mmol/L的患者术中失血量更高（p = 0.012）。仅在乳酸水平>1.5 mmol/L的患者中观察到包括急性肾损伤、ICU住院期间需要急诊手术或原发性移植物功能障碍在内的主要并发症（18.2%）。乳酸>5 mmol/L组（4例患者）的60天死亡率为100%，而乳酸水平<5 mmol/L的患者死亡率为12.5%（p = 0.05）。
肝移植结束时的动脉乳酸浓度与术中失血量增加、ICU住院时间延长及死亡率增加相关。
