Hospital Clínico Universidad de Chile, Unidad de Pacientes Críticos, Departamento Medicina Interna Norte, Santiago, Chile.
Hospital Clínico Universidad de Chile, Unidad de Pacientes Críticos, Departamento Medicina Interna Norte, Santiago, Chile.
Braz J Anesthesiol. 2021 Jan-Feb;71(1):58-64. doi: 10.1016/j.bjane.2020.09.011. Epub 2020 Dec 26.
Postoperative Hyperlactatemia (PO-HL) is a frequent condition associated with poor prognosis. In recent years, there has been growing evidence that adrenergic stimulation may contribute to increased lactate levels. The use of adrenergic agonists for the control of intraoperative hypotension is frequent, and its impact on the development of PO-HL is unknown.
To evaluate whether the use of intraoperative adrenergic agents is associated with the occurrence of PO-HL.
This was a prospective observational study. The inclusion criteria were undergoing elective open colon surgery, being ≥60 years old and signing informed consent. The exclusion criteria were cognitive impairment, unplanned surgery, and anticipated need for postoperative mechanical ventilation. Baseline and intraoperative variables were collected, and arterial lactate data were collected at baseline and every 6 hours postoperatively for 24 hours. Hyperlactatemia was defined as lactate >2.1 mEq.L.
We studied 28 patients, 61% of whom developed hyperlactatemia. The variables associated with PO-HL in the univariate analysis were anesthetic time, the total dose of intraoperative ephedrine, and lower intraoperative central venous oxygen saturation (ScvO). Multivariate analysis confirmed the association between the use of ephedrine (p = 0.004), intraoperative hypotension (p = 0.026), and use of phenylephrine (p = 0.001) with PO-HL.
The use of intraoperative ephedrine, phenylephrine and intraoperative hypotension were independently associated with the development of PO-HL. This finding should lead to new studies in this field, as well as a judicious interpretation of the finding of a postoperative increase in lactate levels.
术后高乳酸血症（PO-HL）是一种与预后不良相关的常见病症。近年来，越来越多的证据表明，肾上腺素能刺激可能导致乳酸水平升高。术中使用肾上腺素能激动剂控制低血压的情况很常见，但它对 PO-HL 发展的影响尚不清楚。
评估术中使用肾上腺素能药物是否与 PO-HL 的发生有关。
这是一项前瞻性观察性研究。纳入标准为择期行开腹结肠手术、年龄≥60 岁并签署知情同意书。排除标准为认知障碍、计划外手术和预计需要术后机械通气。收集基线和术中变量，并在基线和术后 24 小时内每 6 小时采集动脉乳酸数据。高乳酸血症定义为乳酸＞2.1 mEq.L。
我们研究了 28 例患者，其中 61%发生了高乳酸血症。单变量分析中与 PO-HL 相关的变量为麻醉时间、术中麻黄碱总剂量和术中中心静脉血氧饱和度（ScvO）较低。多变量分析证实了术中使用麻黄碱（p=0.004）、术中低血压（p=0.026）和使用苯肾上腺素（p=0.001）与 PO-HL 之间的关联。
术中使用麻黄碱、苯肾上腺素和术中低血压与 PO-HL 的发生独立相关。这一发现应促使在该领域开展新的研究，并对术后乳酸水平升高的发现进行谨慎解释。
