Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
Ann Surg Oncol. 2020 Dec;27(13):4874-4882. doi: 10.1245/s10434-020-08330-y. Epub 2020 Apr 19.
Intraoperative hyperglycemia is associated with infectious complications in general surgery patients. This study aimed to determine if the use of lactated Ringer's (LR) carrier solution during hyperthermic intraperitoneal chemotherapy (HIPEC) would lower the incidence of intraoperative hyperglycemia and improve postoperative outcomes when compared with a standard 1.5% dextrose peritoneal dialysate carrier solution.
This is a retrospective cohort study of 134 patients who underwent HIPEC at the University of Colorado. Perioperative glucose levels and outcomes were compared between patients who were perfused with 1.5% dextrose peritoneal dialysate carrier solution (n = 68) versus LR carrier solution (n = 66).
The study population consisted of patients undergoing HIPEC for appendiceal (50%), colorectal (34%), mesothelioma (8%), and ovarian cancer (5%). Intraoperative severe hyperglycemia (glucose ≥ 180 mg/dL) was significantly more common among patients perfused with a dextrose-containing carrier solution versus those perfused with LR (88% vs. 21%; p < 0.001). Patients in the dextrose cohort had significantly more severe complications (39% vs. 12%; p = 0.034), infectious complications (35% vs. 15%; p = 0.011), and organ space infections (18% vs. 5%: p = 0.026) than the LR cohort. On multivariable analysis, dextrose-containing carrier solution was significantly associated with an increased risk of postoperative infectious complications (HR 5.16; p = 0.006).
Intraoperative hyperglycemia is common when dextrose-containing carrier solution is used during HIPEC, and severe intraoperative hyperglycemia is strongly associated with an increased risk for infectious of complications following HIPEC. LR carrier solution should be routinely used to reduce intraoperative hyperglycemia and its associated risks.
术中高血糖与普通外科患者的感染并发症有关。本研究旨在确定在高温腹腔内化疗（HIPEC）期间使用乳酸林格氏液（LR）载体溶液是否会降低术中高血糖的发生率，并改善术后结果，与标准的 1.5%葡萄糖腹膜透析液载体溶液相比。
这是一项回顾性队列研究，纳入了在科罗拉多大学接受 HIPEC 的 134 名患者。比较了使用 1.5%葡萄糖腹膜透析液载体溶液（n=68）与 LR 载体溶液（n=66）的患者的围手术期血糖水平和结果。
研究人群包括接受 HIPEC 治疗阑尾（50%）、结直肠（34%）、间皮瘤（8%）和卵巢癌（5%）的患者。与接受 LR 灌注的患者相比，接受含葡萄糖载体溶液灌注的患者术中严重高血糖（血糖≥180mg/dL）更为常见（88% vs. 21%；p<0.001）。葡萄糖组患者的严重并发症（39% vs. 12%；p=0.034）、感染并发症（35% vs. 15%；p=0.011）和器官间隙感染（18% vs. 5%；p=0.026）明显更多。多变量分析显示，含葡萄糖载体溶液与术后感染并发症风险增加显著相关（HR 5.16；p=0.006）。
在 HIPEC 期间使用含葡萄糖载体溶液时，术中高血糖很常见，严重术中高血糖与 HIPEC 后感染并发症的风险增加密切相关。LR 载体溶液应常规用于降低术中高血糖及其相关风险。
