Dorathy N Sonia, Payal Yashwant S, Talawar Praveen
Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
J Anaesthesiol Clin Pharmacol. 2025 Jan-Mar;41(1):164-170. doi: 10.4103/joacp.joacp_430_23. Epub 2025 Jan 23.
Major head neck surgeries are often associated with major blood loss requiring blood transfusion. However, in spite of transfusion, patients usually suffer adverse postoperative outcomes. Biomarkers can help in identifying such events early. This observational study was conducted to compare blood lactate and bicarbonate levels as predictors of adverse postoperative outcomes.
Forty-eight adult American Society of Anesthesiologists Physical Status I-III patients met the inclusion criteria. Intraoperative blood loss was managed with stored blood transfusion as per transfusion trigger. Blood lactate and bicarbonate levels were measured preoperatively (Tbas), at the immediate postoperative period (T0), and at 8 h (T8), 16 h (T16), and 24 h (T24) postoperatively. Outcomes such as need for intensive care unit (ICU) admission, length of ICU stay, intraoperative blood transfusion, re-exploration rate, and mortality were recorded.
Blood transfusions and ICU admissions were required in 19 (39.6%) and 24 (50%) patients, respectively. Lactate levels of patients requiring blood transfusion and admission to ICU rose significantly from their baseline (1.30 ± 0.41 mmol/l) to 2.80 ± 1.14 mmol/l at the immediate postoperative period, which fell to 2.06 ± 0.78 mmol/l at 24 h postoperatively, compared to other patients who did not require transfusion and ICU admission ( < 0.001). The bicarbonate value did not show any significant change from its baseline (22.68 ± 1.83 mEq/l) at all time points ( = 0.8). In addition, no significant difference was noted regarding ICU admissions ( = 0.659) or blood transfusions ( = 0.788).
Following major head and neck surgeries, blood lactate level is a good predictor, but bicarbonate is a poor predictor of the need for blood transfusions and ICU admission. Intraoperative blood transfusion failed to prevent rise in blood lactate level, which is taken as a surrogate marker of tissue hypoxia.
重大头颈外科手术常伴有大量失血，需要输血。然而，尽管进行了输血，患者术后通常仍会出现不良后果。生物标志物有助于早期识别此类事件。本观察性研究旨在比较血乳酸和碳酸氢盐水平作为术后不良后果预测指标的情况。
48例美国麻醉医师协会身体状况I - III级的成年患者符合纳入标准。术中失血按照输血触发指标通过输注库存血进行处理。术前（Tbas）、术后即刻（T0）以及术后8小时（T8）、16小时（T16）和24小时（T24）测量血乳酸和碳酸氢盐水平。记录诸如重症监护病房（ICU）入住需求、ICU住院时间、术中输血、再次探查率和死亡率等结果。
分别有19例（39.6%）和24例（50%）患者需要输血和入住ICU。需要输血和入住ICU的患者的乳酸水平从基线值（1.30±0.41 mmol/L）在术后即刻显著升至2.80±1.14 mmol/L，与其他不需要输血和入住ICU的患者相比，术后24小时降至2.06±0.78 mmol/L（P<0.001）。碳酸氢盐值在所有时间点与基线值（22.68±1.83 mEq/L）相比均未显示出任何显著变化（P = 0.8）。此外，在ICU入住（P = 0.659）或输血方面（P = 0.788）未观察到显著差异。
在重大头颈外科手术后，血乳酸水平是输血需求和ICU入住需求的良好预测指标，但碳酸氢盐是较差的预测指标。术中输血未能阻止血乳酸水平升高，血乳酸水平被视为组织缺氧的替代标志物。
