Poeze M, Froon A H, Greve J W, Ramsay G
Department of Surgery, University Hospital Maastricht, The Netherlands.
Br J Surg. 1998 Sep;85(9):1221-4. doi: 10.1046/j.1365-2168.1998.00837.x.
Patients with a ruptured abdominal aortic aneurysm (AAA) are at risk of developing colonic ischaemia after surgery. It is difficult to diagnose this ischaemia at an early stage. D-lactate is produced by intestinal bacteria after ischaemia. L-lactate is released in increased amounts during hypoxia by anaerobic metabolism. This study investigated both variables as a marker for intestinal ischaemia in patients with a ruptured AAA.
Twenty-four patients with ruptured AAA were divided retrospectively into two groups with and without ischaemic complications, as verified by colonoscopy. Blood had been taken on admission to the intensive care unit (ICU). Median time to colonoscopy was 9 days after surgery. As controls, four patients with pneumonia, six healthy subjects, five patients with an elective AAA repair, and six patients with sepsis and acute tubular necrosis were included.
D-lactate level on admission was significantly increased in patients with colonic ischaemia after ruptured AAA compared with the level in patients without ischaemia (P< 0.05), patients with sepsis (P< 0.001), those with pneumonia and healthy subjects (P< 0.01). L-lactate concentration was similar in the group with intestinal complications and in patients without colonic ischaemia; however, L-lactate levels were higher in patients with pneumonia and sepsis than in healthy subjects (P < 0.05).
On admission to the ICU, D-lactate, but not L-lactate, levels may predict later colonic ischaemia following repair of a ruptured AAA.
腹主动脉瘤（AAA）破裂患者术后有发生结肠缺血的风险。早期诊断这种缺血较为困难。缺血后肠道细菌会产生D-乳酸。缺氧时，无氧代谢会使L-乳酸释放量增加。本研究调查了这两个变量作为AAA破裂患者肠道缺血标志物的情况。
24例AAA破裂患者根据结肠镜检查结果回顾性分为有缺血并发症组和无缺血并发症组。患者入住重症监护病房（ICU）时采集血液样本。结肠镜检查的中位时间为术后9天。纳入4例肺炎患者、6例健康受试者、5例择期AAA修复患者和6例脓毒症及急性肾小管坏死患者作为对照。
与无缺血患者（P<0.05）、脓毒症患者（P<0.001）、肺炎患者及健康受试者（P<0.01）相比，AAA破裂后发生结肠缺血患者入院时的D-乳酸水平显著升高。肠道并发症组和无结肠缺血患者的L-乳酸浓度相似；然而，肺炎和脓毒症患者的L-乳酸水平高于健康受试者（P<0.05）。
入住ICU时，D-乳酸水平而非L-乳酸水平可预测AAA破裂修复术后的结肠缺血情况。
