Department of Anaesthesia, Austin Health, 145 Studley Road, Heidelberg, 3084, Australia.
Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, 3084, Australia.
BMC Surg. 2021 Jan 7;21(1):31. doi: 10.1186/s12893-020-01034-w.
It is uncertain whether increases in PaCO during surgery lead to an increase in plasma potassium concentration and, if so, by how much. Hyperkalaemia may result in cardiac arrhythmias, muscle weakness or paralysis. The key objectives were to determine whether increases in PaCO during laparoscopic surgery induce increases in plasma potassium concentrations and, if so, to determine the magnitude of such changes.
A retrospective observational study of adult patients undergoing laparoscopic abdominal surgery was perfomed. The independent association between increases in PaCO and changes in plasma potassium concentration was assessed by performing arterial blood gases within 15 min of induction of anaesthesia and within 15 min of completion of surgery.
289 patients were studied (mean age of 63.2 years; 176 [60.9%] male, and mean body mass index of 29.3 kg/m). At the completion of the surgery, PaCO had increased by 5.18 mmHg (95% CI 4.27 mmHg to 6.09 mmHg) compared to baseline values (P < 0.001) with an associated increase in potassium concentration of 0.25 mmol/L (95% CI 0.20 mmol/L to 0.31 mmol/L, P < 0.001). On multiple regression analysis, PaCO changes significantly predicted immediate changes in plasma potassium concentration and could account for 33.1% of the variance (r = 0.331, f(3,259) = 38.915, P < 0.001). For each 10 mmHg increment of PaCO the plasma potassium concentration increased by 0.18 mmol/L.
In patients receiving laparoscopic abdominal surgery, there is an increase in PaCO at the end of surgery, which is independently associated with an increase in plasma potassium concentration. However, this effect is small and is mostly influenced by intravenous fluid therapy (Plasma-Lyte 148 solution) and the presence of diabetes. Trial registration Retrospectively registered in the Australian New Zealand Clinical Trials Registry (Trial Number: ACTRN12619000716167).
手术期间 PaCO 的升高是否会导致血浆钾浓度升高，如果会，升高幅度是多少，尚不确定。高钾血症可能导致心律失常、肌无力或瘫痪。主要目的是确定腹腔镜手术期间 PaCO 的升高是否会引起血浆钾浓度升高，如果是，确定这种变化的幅度。
对接受腹腔镜腹部手术的成年患者进行回顾性观察性研究。通过在麻醉诱导后 15 分钟内和手术结束后 15 分钟内进行动脉血气分析，评估 PaCO 升高与血浆钾浓度变化之间的独立关联。
共研究了 289 例患者（平均年龄 63.2 岁；176 例[60.9%]为男性，平均体重指数为 29.3kg/m²）。与基线值相比，手术结束时 PaCO 升高了 5.18mmHg（95%CI 4.27mmHg 至 6.09mmHg；P<0.001），钾浓度升高了 0.25mmol/L（95%CI 0.20mmol/L 至 0.31mmol/L，P<0.001）。多元回归分析显示，PaCO 变化可显著预测血浆钾浓度的即时变化，可解释 33.1%的方差（r=0.331，f(3,259)=38.915，P<0.001）。PaCO 每升高 10mmHg，血浆钾浓度升高 0.18mmol/L。
在接受腹腔镜腹部手术的患者中，手术结束时 PaCO 升高，与血浆钾浓度升高独立相关。然而，这种影响很小，主要受静脉输液治疗（Plasma-Lyte 148 溶液）和糖尿病的影响。
在澳大利亚和新西兰临床试验注册中心（注册号：ACTRN12619000716167）进行回顾性注册。
