Gaspari Rita, Teofili Luciana, Ardito Francesco, Adducci Enrica, Vellone Maria, Mele Caterina, Orlando Nicoletta, Iacobucci Tiziana, Antonelli Massimo, Giuliante Felice
Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Biomedicines. 2022 May 10;10(5):1108. doi: 10.3390/biomedicines10051108.
High End-Surgery Arterial Lactate Concentration (ES-ALC) predicts poor outcome after hepatectomy. The aim of this study was to identify intraoperative hemodynamic parameters predicting high ES-ALC during elective liver resection. Patients who underwent liver resection between 2017 and 2018, under FloTrac/EV1000TM hemodynamic monitoring, were included. The ES-ALC cutoff best predicting severe postoperative complications was identified. Association between high ES-ALC and preoperative and intraoperative variables was assessed. 108 patients were included; 90-day mortality was 0.9% and severe morbidity 14.8%. ES-ALC cutoff best discriminating severe complications was 5.05 mmol/L. Patients with ES-ALC > 5.0 mmol/L had a relative risk of severe complications of 2.8% (p = 0.004). High ES-ALC patients had longer surgery and ischemia duration, larger blood losses and higher requirements of fluids and blood transfusions. During surgery, hemoglobin concentration and oxygen delivery (DO2) decreased more significantly in patients with high ES-ALC, although they had similar values of stroke volume and cardiac output to those of other patients. At multivariate analysis, surgery duration and lowest recorded DO2 value were the strongest predictors of high ES-ALC. ES-ALC > 5.0 mmol/L in elective liver resection predicts postoperative morbidity and is essentially driven by the impaired DO2. Timely correction of blood losses might prevent the ES-ALC increase.
高端手术动脉乳酸浓度（ES-ALC）可预测肝切除术后的不良预后。本研究旨在确定择期肝切除术中预测高ES-ALC的术中血流动力学参数。纳入2017年至2018年间在FloTrac/EV1000TM血流动力学监测下接受肝切除术的患者。确定了最能预测严重术后并发症的ES-ALC临界值。评估了高ES-ALC与术前及术中变量之间的关联。纳入108例患者；90天死亡率为0.9%，严重并发症发生率为14.8%。最能区分严重并发症的ES-ALC临界值为5.05 mmol/L。ES-ALC>5.0 mmol/L的患者发生严重并发症的相对风险为2.8%（p = 0.004）。ES-ALC高的患者手术时间和缺血时间更长，失血量更大，液体和输血需求量更高。手术期间，ES-ALC高的患者血红蛋白浓度和氧输送（DO2）下降更显著，尽管他们的每搏量和心输出量与其他患者相似。多因素分析显示，手术时间和记录到的最低DO2值是高ES-ALC的最强预测因素。择期肝切除术中ES-ALC>5.0 mmol/L可预测术后并发症，主要是由DO2受损所致。及时纠正失血可能会防止ES-ALC升高。
