关键词: 高乳酸血症, 手术后并发症, 危险因素, 腹主动脉球囊, 骶骨骨盆肿瘤切除术

Abstract: Objective To analyze relevant factors for intraoperative hyperlactacidemia in patients selected for surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion and explore the relationship between intraoperative hyperlactacidemia and postoperative complications. Methods The clinical data of 341 patients underwent surgical excision of pelvic and sacrum tumors assisted by abdominal aortic balloon occlusion in Peking University People’s Hospital from May 3, 2016 to May 3, 2018 were retrospectively analyzed. Logistic regression analysis was performed on factors including age, gender, American Association of Anesthesiologists (ASA) classification, body mass index (BMI),preoperative hemoglobin content, preoperative albumin content, surgery time, blood loss, urine output, total occlusion time of aortic balloon and lactate levels. Data of post-operative cardiac，pulmonary and neurological system complications and surgical wound infection were also collected. The patients were divided into hyperlactacidemia group (n=71) and control group (n=270) according to whether hyperlactacidemia developed during the operation. The incidences of postoperative complications were also compared between the two groups. Results Seventy-one patients (71 / 341, 20.82%) developed intraoperative hyperlactacidemia. Multivariate Logistic regression analysis showed that total occlusion time of aortic balloon(＞60 min) and blood loss(＞4 000 mL) were the independent risk factors of intraoperative hyperlactacidemia. The incidence of post-operative pulmonary complications was significantly higher in patients with intraoperative hyperlactacidemia than that in patients without intraoperative hyperlactacidemia (P＜0.05). There were no significant differences in incidences of post-operative cardiac and neurological system complications and the incidence of postoperative wound infection between the two groups (P＞0.05). Conclusion Patients with total occlusion time of aortic balloon more than 60 min and intraoperative blood loss more than 4 000 mL are prone to intraoperative hyperlactacidemia. Patients with intraoperative hyperlactacidemia are associated with higher incidence of post-operative pulmonary complications than patients without intraoperative hyperlactacidemia. Special attention should be given to these patients.

Key words: hyperlactacidemia, postoperative complications, risk factors, abdominal aortic balloon, surgical excision of pelvic and sacrum tumors