Björck M, Hedberg B
Department of Surgery, University Hospital of Northern Sweden, Umeå.
Br J Surg. 1994 Jan;81(1):25-30. doi: 10.1002/bjs.1800810108.
The early detection and reversal of gastrointestinal ischaemia is thought to play a key role in minimizing the incidence of complications after abdominal aortic surgery. In an open prospective non-selective study intramucosal pH (pHi) was monitored in 27 patients undergoing elective aortic surgery and in seven submitted to emergency procedures. The pHi was monitored in the sigmoid colon in all 34 patients and in the stomach in 26. Eight patients developed major complications, four of whom had ischaemic colitis, and five died. Sigmoid acidosis (pHi below 7.10) served as an early warning; if acidosis was reversed within 2 h no major complication developed, if prolonged it was predictive of major morbidity (sensitivity 100 per cent, specificity 92 per cent). A colonic pHi below 6.86 predicted endoscopically detectable ischaemic colitis. A gastric pHi below 7.20 predicted major complications with a sensitivity of 100 per cent and specificity of 81 per cent. Both monitoring procedures were considered feasible, although monitoring in the sigmoid colon was found to be superior for the patients studied.
胃肠道缺血的早期检测与逆转被认为在降低腹主动脉手术后并发症发生率方面起着关键作用。在一项开放性前瞻性非选择性研究中，对27例行择期主动脉手术的患者和7例接受急诊手术的患者进行了黏膜内pH值（pHi）监测。34例患者均监测了乙状结肠的pHi，26例监测了胃的pHi。8例患者出现严重并发症，其中4例患有缺血性结肠炎，5例死亡。乙状结肠酸中毒（pHi低于7.10）可作为早期预警；如果酸中毒在2小时内得到逆转，则不会发生严重并发症，如果持续存在，则预示着严重发病（敏感性100%，特异性92%）。结肠pHi低于6.86可预测内镜可检测到的缺血性结肠炎。胃pHi低于7.20预测严重并发症的敏感性为100%，特异性为81%。尽管发现对所研究的患者而言，监测乙状结肠的pHi更具优势，但两种监测方法均被认为是可行的。
