Meng Yu, Pei Huan-Shuang, Yu Jia-Jia
Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China.
World J Clin Cases. 2023 Mar 16;11(8):1869-1877. doi: 10.12998/wjcc.v11.i8.1869.
Intraoperative hyperlactatemia often affects circulatory stability, vital organ function, and postoperative recovery, poses a serious prognostic risk, and requires considerable attention from anesthesiologists. Here, we describe a case of hyperlactatemia during the postoperative resection of liver metastases after chemotherapy for sigmoid colon cancer. This did not affect the patient's circulatory stability or quality of awakening, which is rarely reported in clinical practice. We present our management experience with the aim of providing a reference for future studies and clinical practice.
A 70-year-old female patient was diagnosed with postoperative liver metastasis following chemotherapy for sigmoid colon cancer. Laparoscopic right hemicolectomy and cholecystectomy under general anesthesia were required. Metabolic disorders, primarily hyperlactatemia, often occur intraoperatively. After treatment, other indices quickly returned to normal, lactate levels decreased slowly, and hyperlactatemia persisted during the awakening period. However, this did not affect the patient's circulatory stability or awakening quality. This condition has rarely been clinically reported. Therefore, we report our management experience in order to guide clinical practice in this regard. Hyperlactatemia did not affect circulatory stability or the quality of awakening. We considered that active intraoperative rehydration avoided serious harm to the organism caused by hyperlactatemia due to insufficient tissue perfusion, while hyperlactatemia caused by decreased lactate clearance due to impaired liver function associated with surgical resection had a mild effect on the function of important organs.
Active intraoperative rehydration avoided serious harm to the organism caused by hyperlactatemia. Strengthening body temperature protection could improve lactate circulation.
术中高乳酸血症常影响循环稳定性、重要器官功能及术后恢复，带来严重的预后风险，需要麻醉医生予以高度关注。在此，我们描述一例乙状结肠癌化疗后肝转移瘤切除术后出现高乳酸血症的病例。此情况未影响患者的循环稳定性及苏醒质量，这在临床实践中鲜有报道。我们介绍我们的处理经验，旨在为未来研究及临床实践提供参考。
一名70岁女性患者在乙状结肠癌化疗后被诊断为术后肝转移。需要在全身麻醉下进行腹腔镜右半结肠切除术和胆囊切除术。术中常发生代谢紊乱，主要是高乳酸血症。治疗后，其他指标迅速恢复正常，乳酸水平缓慢下降，且在苏醒期高乳酸血症持续存在。然而，这并未影响患者的循环稳定性及苏醒质量。这种情况在临床上鲜有报道。因此，我们报告我们的处理经验以指导这方面的临床实践。高乳酸血症未影响循环稳定性及苏醒质量。我们认为术中积极补液避免了因组织灌注不足导致的高乳酸血症对机体造成严重损害，而手术切除相关肝功能受损导致乳酸清除减少引起的高乳酸血症对重要器官功能影响较轻。
术中积极补液避免了高乳酸血症对机体造成严重损害。加强体温保护可改善乳酸循环。
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