Rauserova-Lexmaulova Leona, Vanova-Uhrikova Ivana, Rehakova Kristina
Department of Surgery and Orthopedics, Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic.
Small Animal Clinical Laboratory, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic.
Top Companion Anim Med. 2020 Jun;39:100403. doi: 10.1016/j.tcam.2020.100403. Epub 2020 Jan 14.
Gastric dilation-volvulus (GDV) syndrome in dogs is associated with complex metabolic, acid-base, and electrolyte abnormalities. The aim of this study was to evaluate previously analyzed factors (lactate and BE) in combination with other acid-base parameters (pH, pCO, bicarbonate, base excess [BE], anion gap [AG], and strong ion difference) and electrolyte concentrations and to evaluate their association with the incidence of gastric necrosis and outcome in dogs with GDV. A retrospective study in 75 dogs with gastric dilation-volvulus syndrome, University veterinary teaching hospital. Medical records were reviewed including signalment, history, initial plasma lactate, acid-base parameters, and electrolyte concentrations, surgical findings and outcome. The overall mortality was 18.7%. In dogs with gastric necrosis, higher initial plasma lactate (median 5.84 vs. 3.36 mmol/L) and AG (20.7 vs. 16.55 mmol/L) and lower pH (7.29 vs. 7.36), bicarbonate (18.7 vs. 22.9 mmol/L), and BE concentration (-8.1 vs. -1.85 mmol/L) were found compared to dogs without gastric necrosis. Anorganic phosphorus was the only electrolyte investigated for which a significant difference was noted between dogs with and without gastric necrosis (1.93 vs. 1.39 mmol/L). The initial plasma lactate concentration (3.36 mmol/L vs. 9.68 mmol/L) and AG (16.8 vs. 20.95 mmol/L) were lower in survivors than nonsurvivors. Survivors had higher pH (7.35 vs. 7.27), bicarbonate concentrations (22.9 vs. 17.35 mmol/L), and BE (-1.9 vs. -9.55 mmol/L) compared to nonsurvivors. Anorganic phosphorus was ultimately the only electrolyte with a significant difference between survivors and nonsurvivors (1.4 vs. 1.84 mmol/L). A multivariate logistic regression model of combination lactate, pH, bicarbonate, BE, AG, and anorganic phosphorus identified pH ≤7.331 and bicarbonate as factors independently associated with gastric necrosis. Similarly, pH ˃7.331, bicarbonate and anorganic phosphorus were independently associated with outcome. Higher initial plasma lactate, AG and anorganic phosphorus levels, and lower pH, BE and bicarbonate concentrations were found in GDV dogs with gastric necrosis. Similarly, initially higher plasma lactate, AG and anorganic phosphorus concentrations, and lower pH, BE and bicarbonate were found in GDV dogs who required euthanasia or who died after surgery. Of these parameters, pH and bicarbonate were strongly and independently associated with gastric necrosis, and pH, bicarbonate and phosphorus were independently associated with outcome.
犬胃扩张-扭转（GDV）综合征与复杂的代谢、酸碱及电解质异常有关。本研究的目的是评估先前分析的因素（乳酸和碱剩余[BE]）与其他酸碱参数（pH、二氧化碳分压[pCO₂]、碳酸氢盐、碱剩余[BE]、阴离子间隙[AG]和强离子差）及电解质浓度的组合，并评估它们与GDV患犬胃坏死发生率和预后的相关性。在大学兽医教学医院对75例患有胃扩张-扭转综合征的犬进行了一项回顾性研究。回顾了病历，包括特征、病史、初始血浆乳酸、酸碱参数、电解质浓度、手术结果和预后。总体死亡率为18.7%。与无胃坏死的犬相比，有胃坏死的犬初始血浆乳酸水平更高（中位数5.84对3.36 mmol/L）、AG更高（20.7对16.55 mmol/L），而pH更低（7.29对7.36）、碳酸氢盐更低（18.7对22.9 mmol/L）以及BE浓度更低（-8.1对-1.85 mmol/L）。无机磷是唯一一项在有胃坏死和无胃坏死的犬之间存在显著差异的电解质（1.93对1.39 mmol/L）。幸存者的初始血浆乳酸浓度（3.36 mmol/L对9.68 mmol/L）和AG（16.8对20.95 mmol/L）低于非幸存者。与非幸存者相比，幸存者的pH更高（7.35对7.27）、碳酸氢盐浓度更高（22.9对17.35 mmol/L）以及BE更高（-1.9对-9.55 mmol/L）。无机磷最终是唯一一项在幸存者和非幸存者之间存在显著差异的电解质（1.4对1.84 mmol/L）。乳酸、pH、碳酸氢盐、BE、AG和无机磷组合的多因素逻辑回归模型确定pH≤7.331和碳酸氢盐是与胃坏死独立相关的因素。同样，pH＞7.331、碳酸氢盐和无机磷与预后独立相关。在患有胃坏死的GDV犬中发现初始血浆乳酸、AG和无机磷水平更高，而pH、BE和碳酸氢盐浓度更低。同样，在需要安乐死或术后死亡的GDV犬中，最初血浆乳酸、AG和无机磷浓度更高，而pH、BE和碳酸氢盐更低。在这些参数中，pH和碳酸氢盐与胃坏死强烈且独立相关，而pH、碳酸氢盐和磷与预后独立相关。
