Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
The First Clinical College, Southern Medical University, Guangzhou, Guangdong, China.
Langenbecks Arch Surg. 2020 Aug;405(5):603-611. doi: 10.1007/s00423-020-01922-y. Epub 2020 Jul 24.
Emerging evidences have raised concerns about electrolyte disorders caused by restrictive fluid management in the enhanced recovery after surgery (ERAS) protocol. This study aims to investigate the morbidity and treatment of electrolyte disorders associated with ERAS in patients undergoing hepato-pancreato-biliary (HPB) surgery.
Clinical data from 157 patients under the ERAS program and 166 patients under the traditional (Non-ERAS) program after HPB surgery were retrospectively analyzed. Risk factors and predictive factors of postoperative electrolyte disorders were analyzed by logistic regression analysis and receiver operator characteristic (ROC) curve analysis, respectively.
The average of intravenous fluid, sodium, chloride, and potassium supplementation after surgery were significantly lower in the ERAS group. Hypokalemia was the most common type of electrolyte disorders in the ERAS group, whose incidence was substantially increased compared to that in the Non-ERAS group [28.77% vs. 8.97%, p < 0.001, on postoperative (POD) 5]. Logistic regression analysis identified the ERAS program and age as independent risk factors of hypokalemia. ROC curve analysis identified serum potassium levels below 3.76 mmol/L on POD 3 (area under curve 0.731, sensitivity 58.54%, specificity 82.69%) as a predictive factor for postoperative hypokalemia in ERAS patients. Oral supplementation at an average of 35.41 mmol potassium per day was effective in restoring the ERAS-associated hypokalemia.
ERAS procedures were particularly associated with a lower supplementation of potassium and a higher incidence of hypokalemia in patients after HPB surgery. Oral potassium supplementation could be an adopted ERAS program for the elderly undergoing HPB surgery.
术后加速康复（ERAS）方案中限制液体管理引起的电解质紊乱引起了人们的关注。本研究旨在探讨肝胆胰（HPB）手术后 ERAS 患者与 ERAS 相关的电解质紊乱的发病率和治疗方法。
回顾性分析了 157 例接受 ERAS 方案和 166 例接受传统（非 ERAS）方案的 HPB 手术后患者的临床资料。采用逻辑回归分析和受试者工作特征（ROC）曲线分析分别分析术后电解质紊乱的危险因素和预测因素。
ERAS 组术后静脉补液、钠、氯和钾的补充量明显低于非 ERAS 组。低钾血症是 ERAS 组最常见的电解质紊乱类型，其发生率明显高于非 ERAS 组[28.77%比 8.97%，p<0.001，术后第 5 天]。逻辑回归分析确定 ERAS 方案和年龄是低钾血症的独立危险因素。ROC 曲线分析确定术后第 3 天血清钾水平<3.76mmol/L（曲线下面积 0.731，敏感性 58.54%，特异性 82.69%）是 ERAS 患者术后低钾血症的预测因素。平均每天补充 35.41mmol 钾的口服补充对恢复 ERAS 相关低钾血症有效。
ERAS 方案与 HPB 手术后患者钾补充量较低和低钾血症发生率较高特别相关。对于接受 HPB 手术的老年患者，口服钾补充可能是一种可采用的 ERAS 方案。
