后腹腔镜手术并发高乳酸血症的危险因素分析

目的分析后腹腔镜术中患者血乳酸浓度升高的危险因素。方法收集2018年1月1日至2019年6月30日在山西医科大学第一医院行后腹腔镜手术患者的临床资料,按术中乳酸增高与否分为乳酸增高组和乳酸正常组。对患者相关资料进行单因素及多因素Logistic回归分析。结果726例患者中乳酸增高76例(10.5%)。单因素分析显示,乳酸增高组肝功能Child-Pugh评分、血肌酐浓度、体质量指数、手术时间、气腹时间、气腹期间膀胱压、术中持续性低血压、嗜铬细胞瘤切除术例数大于乳酸正常组,尿量少于乳酸正常组(P<0.05)。多因素Logistic回归分析显示肝功能Child-Pugh评分(OR=1.134,95%CI 1.083~1.189,P<0.001),血肌酐浓度(OR=1.134,95%CI 1.083~1.189,P<0.001),气腹时长(OR=1.021,95%CI 1.001~1.042,P=0.043),嗜铬细胞瘤切除术(OR=5.146,95%CI 1.229~21.543,P=0.025),术中持续性低血压(OR=12.956,95%CI 2.028~82.753,P=0.007)是患者乳酸升高的危险因素。结论肝功能Child-Pugh评分高、血肌酐浓度高、气腹时间长、嗜铬细胞瘤切除术、术中持续性低血压是后腹腔镜术中患者乳酸升高的独立危险因素。

Analysis of risk factors for hyperlactatemia in retroperitoneoscopic surgery

Objective To analyze the risk factors for hyperlactatemia in patients undergoing retroperitoneoscopic surgery.Methods The clinical data were collected from patients who underwent retroperitoneoscopic surgery in the First Hospital of Shanxi Medical University from January 1,2018 to June 30,2019.The patients were divided into high lactate group and normal lactate group according to the lactate value during the operation.To analyze the relevant data by univariate analysis and multivariate Logistic regression analysis.Results Among 726 patients,76(10.5%)cases lactate value increased.Univariate analysis showed that the liver Child-Pugh score,serum creatinine concentration,BMI,duration of operation and pneumoperitoneum,bladder pressure during the pneumoperitoneum,occurrence of prolonged hypotension and the cases of pheochromocytoma resection in the high lactate group were higher than those in the normal lactate group,the urine volume was lower,with statistically signficant differences(P<0.05).Multivariate Logistic regression analysis showed that the liver Child-Pugh score(OR=9.776,95%CI 4.689-20.383,P<0.001),the serum creatinine concentration(OR=1.134,95%CI 1.083-1.189,P<0.001),the duration of pneumoperitoneum(OR=1.021,95%CI 1.001-1.042,P=0.043),pheochromocytoma resection(OR=5.146,95%CI 1.229-21.543,P=0.025),prolonged hypotension(OR=12.956,95%CI 2.028-82.753,P=0.007)were risk factors of hyperlactatemia for retroperitoneoscopic surgery.Conclusion The preoperetive liver Child-Pugh score,serum creatinine concentration,pneumoperitoneum duration,pheochromocytoma resection and prolonged hypotension are the independent risk factors of hyperlactatemia in retroperitoneoscopic surgery.