Abstract:

Effect of perioperation care on serum arterial lactate value and lactate clearance rate in patients undergoing partial hepatectomy under fluid restriction        YU Ling, SUN Hong-wei, JIN Huang-mo, et al. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education); Department of Anesthesiology, Peking University Cancer Hospital & Institute，Beijing 100142, China
Corresponding author:TAN Hong-yu，E-mail：maggitan@163.com
Abstract    Objective    To investigate the related factors of serum arterial lactate concentration in hepatectomy patients with fluid restriction before resection of liver lesions. Methods    Patients classified as ASA Ⅰor Ⅱwho had been chosen for an open procedure were candidated for elective liver resections at our hospital between  Jun 2017 and Dec 2017.Limited fluid was infused at rate 6 mL/(kg·h) before liver resection. The infusion speed was quickened after resection of liver lesion. Patients’ demographic data，portal triad clamping period were recorded. All serum arterial lactate concentration were measured by arterial blood gas analysis during perioperation. Results    In 67 patients，the blood lactate value increased significantly at 10 minutes after the end of resection of the liver lesion （T3）and T4 at end of  leaving recovery room（T4）.There was significant positive correlation between the lactate value at T3 and T4 the duration of portal triad clamping （P<0.001）. There was no significant correlation between the lactate value during perioperation and the number of ephedrine, the number of rapid fluid bolus, the amount of blood loss, the value of CVP during hepatectomy and liver cirrhosis. Conclusion    Hepatic portal clamping increases the value of arterial blood lactate in patients with undergoing hepatectomy. The blood lactate clearance rate is positive while liquid infusion is accelerated after liver resection.

Key words: serum arterial lactate concentration, lactate clearance rate, partial hepatectomy;  , portal triad clamping

摘要：

目的    研究肝部分切除病人在肝脏病灶切除前限制液体输注、围手术期处理对动脉血乳酸值的影响因素。方法    选择2017年6-12月北京大学肿瘤医院行开腹肝脏部分切除的美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级病人为研究对象，肝脏病灶切除前限制液体输注速度为6 mL/（kg·h）。肝脏病灶切除后加快输液速度。测定围手术期动脉血乳酸值，计算血乳酸清除率。结果    67例病人中，肝脏病灶切除后10 min（T3）和出恢复室前（T4）血乳酸值明显增高。T3和T4血乳酸值与肝门阻断时间有显著正相关性（P<0.001）。各时间点血乳酸值与给麻黄碱次数、快速补液次数、出血量、肝脏切除期间中心静脉压（CVP）均值以及是否存在肝硬化无相关性。血乳酸清除率均值为正值。结论    肝门阻断可增加血乳酸值。病灶切除后加快输液可维持血乳酸清除率为正值。

关键词: 血乳酸值, 乳酸清除率, 肝部分切除术, 肝门阻断