Wada Y, Mori K, Sugano M, Fujii T, Shimahara Y, Yamaoka Y, Ozawa K
Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
World J Surg. 1993 Jan-Feb;17(1):116-20; discussion 120-1. doi: 10.1007/BF01655722.
The acid-base balance from the postoperative day (POD) 1 to POD 3 after cirrhotic liver resection was investigated in relation to operative outcome by conducting a retrospective study on the changes in arterial ketone body ratio (AKBR), which reflects the hepatic mitochondrial redox state, and arterial blood gas analysis. Patients were grouped according to their outcome: hospital death (HD) and or good outcome, the latter group acting as controls (CTR). Metabolic alkalosis developed in a significant number of the CTR patients (p < 0.01), who had high AKBR values. By contrast, metabolic alkalosis did not develop in the HD group, with significantly lower AKBR (p < 0.001), and there was almost normobasemia. There were no significant differences in the need for mechanical respiratory assistance, the amounts of fresh frozen plasma administered, and renal function test results between the two groups on each of 3 postoperative days. These data indicated that the absence of metabolic alkalosis during the early postoperative days reflects disruption of energy metabolism in the remnant liver, and that the apparent normobasemia is a significant indicator of poor prognosis after cirrhotic liver resection.
通过对反映肝线粒体氧化还原状态的动脉酮体比率（AKBR）变化进行回顾性研究，并结合动脉血气分析，探讨肝硬化肝切除术后第1天（POD 1）至POD 3的酸碱平衡与手术结果的关系。根据患者的结局进行分组：医院死亡（HD）组和预后良好组，后者作为对照组（CTR）。大量CTR组患者（p < 0.01）出现代谢性碱中毒，这些患者的AKBR值较高。相比之下，HD组未出现代谢性碱中毒，其AKBR显著较低（p < 0.001），且几乎为正常碱血症。术后3天中，两组在机械通气辅助需求、新鲜冰冻血浆输注量及肾功能测试结果方面均无显著差异。这些数据表明，术后早期无代谢性碱中毒反映了残余肝能量代谢的紊乱，而明显的正常碱血症是肝硬化肝切除术后预后不良的重要指标。
