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血清乳酸水平变化可预测胰腺切除术后腹腔内感染。

Changes in Serum Lactate Level Predict Postoperative Intra-Abdominal Infection After Pancreatic Resection.

机构信息

Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China.

Department of Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.

出版信息

World J Surg. 2021 Jun;45(6):1877-1886. doi: 10.1007/s00268-021-05987-8. Epub 2021 Feb 18.

Abstract

OBJECTIVE

Postoperative intra-abdominal infection is one of the most serious complications after pancreatic resection. In this article, we investigated the relationship between serum lactate level and postoperative infection, to suggest a new predictor of potential infection risk after pancreatectomy.

METHODS

A retrospective analysis of 156 patients who underwent pancreatic surgery and admitted in the intensive care unit for recovery after surgery between August 2017 and August 2019 was performed.

RESULTS

The basic characteristics, preoperative information, pathological diagnoses, surgical methods, and intraoperative situations of patients in the postoperative intra-abdominal infection group (n = 52) and non-infection group (n = 104) showed no significant differences. With the same postoperative treatments and results of fluid balance, blood pressure maintenance, and laboratory tests, postoperative serum lactate level increased much higher in the infection group than non-infection group (P < 0.001), while the base excess level declined much lower (P = 0.002). Patients in the infection group needed more time to elute lactate (P < 0.001), and stayed longer in the intensive care unit after surgery (P = 0.007). The overall postoperative complications were certainly more in the infection group (P < 0.001), resulting in a longer hospitalization time (P < 0.001).

CONCLUSIONS

When patients recovered smoothly from anesthesia with a stable hemodynamics situation and normal results of laboratory tests, abnormally high serum lactate level could be a predictor of postoperative intra-abdominal infection after pancreatic resection.

摘要

目的

术后腹腔感染是胰腺切除术后最严重的并发症之一。本文旨在探讨血清乳酸水平与术后感染的关系,以期为胰腺切除术后感染风险提供新的预测指标。

方法

回顾性分析了 2017 年 8 月至 2019 年 8 月期间在重症监护病房接受胰腺手术后恢复的 156 例患者的资料。

结果

术后腹腔感染组(n=52)和非感染组(n=104)患者的基本特征、术前信息、病理诊断、手术方法和术中情况无显著差异。在相同的术后治疗和结果下,如液体平衡、血压维持和实验室检查,感染组术后血清乳酸水平升高显著高于非感染组(P<0.001),而碱剩余水平降低显著低于非感染组(P=0.002)。感染组患者乳酸清除时间更长(P<0.001),术后在重症监护病房停留时间更长(P=0.007)。感染组的总体术后并发症更多(P<0.001),导致住院时间延长(P<0.001)。

结论

当患者在麻醉苏醒后血流动力学稳定且实验室检查结果正常时,血清乳酸水平异常升高可能是胰腺切除术后腹腔内感染的预测指标。

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