术中隐匿性休克对胃癌D2／D3根治术并发症的影响

目的：回顾性分析胃癌D2/D3根治术隐匿性休克的发生率及术后并发症率。方法共选取我院2009年3月至2013年6月胃癌D2/D3根治术老年患者126例，根据动脉血乳酸及收缩压将病例分成三组，即隐匿性休克组、显性休克组、无休克组。隐匿性休克患者占23．8％（30/126），显性休克患者占7．1％（9/126），无休克患者占69．1％（87/126）。比较三组术后并发症的差异性。结果术后7 d并发症，隐匿性休克组为16．7％（95％ CI 10～31），显性休克组为22．2％（95％ CI 11～36），无休克组为1．1％（95％ CI 1～3）。隐匿性休克组和显性休克组术后并发症发生率相当，差异无统计学意义（P ＝0．953）。结论胃癌D2/D3根治术术中隐匿性休克发生率高，术后并发症发生率与显性休克相当，应引起临床医护人员的重视，及早识别并治疗。

Effect of intraoperative cryptic shock on the prognosis of D2/D3 radical resection for gastric carci-noma

Objective To analyze the incidence of cryptic shock and postoperative complications after D2/D3 radical resection for gastric carcinoma retrospectively.Methods From March 2009 to June 2013,126 elderly patients with D2/D3 radical resection for gastric carcinoma were enrolled.According to the levels of arterial blood lactate and systolic blood pressure,the patients were divided into three groups, including 23.8%（30/126）of cryptic shock,7.1%（9/126）of overt shock and 69.1%（87/126）with no shock.Differences in postoperative complications were compared among groups.Results At the 7th day after operation,the rates of complications were 16.7%（95% CI 10～31）in the cryptic shock group,22. 2%（95% CI 11 ～36）in the overt shock group and 1.1%（95% CI 1～3）in the no shock group.There was no difference in complications between the cryptic shock group and overt shock group（P=0.953）. Conclusion During the D2/D3 radical resection for gastric carcinoma,the incidence of cryptic shock is high and it carries a similar complication rate as the overt shock.It should cause the attention of clinical staffs and require early identification and management.