«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

21卷

期数:

2015年04期

页码:

317-320

栏目:

临床医学

出版日期:

2015-07-15

文章信息/Info

Title:

Lactate clearance rate predicting postoperative complications after radical esophagectomy for cancer

文章编号:

1006-8147（2015）04-0317-04

作者:

杜卓然¹; 张 鹏²; 刘毅梅²; 张 辉²; 陈 渊²; 崔元涛²; 董尚文² 

（1.天津医科大学研究生院，天津 300070；2.天津医科大学总医院心胸外科，天津 300052）

Author(s):

DU Zhuo-ran; ZHANG Peng; LIU Yi-mei; ZHANG Hui; CHEN Yuan; DONG Shang-wen

 （1. Graduate School, Tianjin Medical University，Tianjin 300070, China; 2.Department of Thoracic Surgery，General Hospital，Tianjin Medical University，Tianjin 300052，China）

关键词:

食管癌; 乳酸清除率; 早期并发症

' target="_blank" rel="external"> TEXT-ALIGN: left" align="left">

Keywords:

esophageal carcinoma;  lactate clearance;  early complication

分类号:

R735.1

DOI:

-

文献标志码:

A

摘要:

目的 ：研究不同时间动脉血乳酸清除率（LCR）对食管癌根治术术后并发症的预测价值。方法：回顾研究82例食管癌根治术后患者临床资料，根据有无并发症分为并发症组和无并发症组。比较两组术后6 h、24 h和48 h LCR、APACHEⅡ（急性生理学及慢性健康状况评分），判断术后并发症的危险因素,用多元Logistic分析独立危险因素， ROC曲线评价预测价值。结果：并发症组6 h[(12.9±5.6)%vs.(38.2±14.7)%,P＜0.001]、24 h[(33.8±17.7)%vs.(58.2±13.5)%,P＜0.001]、48 h[(55.7±18.8)%vs.(71.7±11.4)%,P＜0.001]乳酸清除率明显低于无并发症组，并发症组APACHEⅡ评分[（16.1±4.5）分 vs.（13.5±2.4）分,P＜0.001]明显高于无并发症组，差异具有统计学意义。多元Logistic回归分析示：6 h乳酸清除率是术后并发症的危险因素。6 h 、24 h 、48 h乳酸清除率ROC曲线下面积分别是0.984、0.848、0.774。结论：6 h乳酸清除率可作为预测食管癌根治术后并发症的可靠指标。

Abstract:

Objective: To assess the role of lactate clearance rate(LCR) over time in predicting early postoperative complications led by radical esophagectomy for cancer. Methods: Data of 82 patients undergoing open thoracic esophagectomy were prospectively analyzed. According to the condition of complications, patients were divided into two groups: complication group and non-complication group. Comparison of APACHEⅡ (Acute Physiology and Chronic Health Evaluation)，LCR at 6 h，24 h，48 h and other parameters between two groups and Logistic regression were applied to identify risk factors of postoperative complications and ROC curve to investigate its role. Results： With significant difference, 6 h[(12.9±5.6)% vs.(38.2±14.7)%,P＜0.001]，24 h[(33.8±17.7)%vs.(58.2±13.5)%,P＜0.001]，48 h[(55.7±18.8)%vs.(71.7±11.4)%,P＜0.001] LCR of complication group was lower than that of non-complication group while APACHEⅡ score[（16.1±4.5） vs.（13.5±2.4）,P＜0.001] was significantly different two the groups. Multivariate Logistic regression analysis showed 6 h lactate clearance was an independent risk factor for postoperative complications. Areas under the ROC curve of 6 h，24h and 48h LCR were 0.984，0.848 and 0.774. Conclusion: 6 h LCR can be regarded as a reliable predictor of postoperative complications after open thoracic radical esophagectomy for cancer.

参考文献/References:

[1] Bosch D J, Pultrum B B, De Bock G H, et al. Comparison of different risk-adjustment models in assessing short-term surgical outcome after transthoracic esophagectomy in patients with esophageal cancer[J]. Am J Surg, 2011,202（3）:303

[2] Derogar M, Orsini N, Sadr-Azodi O, et al. Influence of major postoperative complications on health-related quality of life among long-term survivors of esophageal cancer surgery[J]. J Clin Oncol, 2012,30（14）:1615

[3] Meregalli A, Oliveira R P, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients[J]. Crit Care, 2004, 8（2）:R60

[4] Kazan R, Bracco D, Hemmerling T M. Reduced cerebral oxygen saturation measured by absolute cerebral oximetry during thoracic surgery correlates with postoperative complications[J]. Br J Anaesth, 2009,103（6）:811

[5] Odom S R, Howell M D, Silva G S, et al. Lactate clearance as a predictor of mortality in trauma patients[J]. J Trauma Acute Care Surg, 2013,74（4）:999

[6] Callaway D W, Shapiro N I, Donnino M W, et al. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients[J]. J Trauma, 2009, 66（4）:1040

[7] Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis[J]. Crit Care Med, 2014, 42（9）:2118

[8] Mcnelis J, Marini C P, Jurkiewicz A, et al. Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit[J]. Am J Surg , 2001,182（5）:481

[9] Crea N, Di Fabio F, Pata G, et al. APACHE II, POSSUM, and ASA scores and the risk of perioperative complications in patients with colorectal disease[J]. Ann Ital Chir, 2009, 80（3）:177

[10] Jansen T C, Van Bommel J, Schoonderbeek F J, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial[J]. Am J Respir Crit Care Med, 2010, 182（6）:752

[11] Arnold Ryan C, Shapiro Nathan I, Jones Alan E, et al. Multicenter study of rarly lactate clearance as a determinant of survival in patients with presumed sepsis[J]. Shock, 2009, 32（1）:35

[12] Jones A E, Shapiro N I, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial[J]. JAMA, 2010,303（8）:739

[13] 朱晓莉,赵云峰,林勇.早期乳酸清除率对呼吸衰竭患者预后判定的意义[J]. 中华结核和呼吸杂志, 2010, 33（3）:183

[14] Donnino M W, Miller J, Goyal N, et al. Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients[J]. Resuscitation, 2007, 75（2）:229

[15] Nguyen H B, Loomba M, Yang J J, et al. Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock[J]. J Inflamm (Lond), 2010,7：6

[16] 张应天,朱国超,赵建国,等.乳酸清除率预测胃癌D2/D3根治术术后并发症的研究[J].中华临床医师杂志, 2014, 8(9）:1601

[17] Gilani M T, Razavi M, Azad A M. A comparison of simplified acute physiology score II, acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation III scoring system in predicting mortality and length of stay at surgical intensive care unit[J]. Niger Med J, 2014,55（2）:144

[18] Beck D H, Smith G B, Pappachan J V, et al. External validation of the SAPS II, APACHE II and APACHE III prognostic models in South England: a multicentre study[J]. Intensive Care Med, 2003, 29（2）:249

[19] 殷应勇,张鸿,赵杨.6小时乳酸清除率在感染性休克疗效及预后评估中的价值[J]. 中国社区医师, 2013, 15（10）:73

相似文献/References:

[1]周 雯,朱 湘,王 健,等.18F-FDG PET/CT显像在食管癌分期时发现同时性重复癌的价值[J].天津医科大学学报,2015,21(05):404.
　ZHOU Wen,ZHU Xiang,WANG Jian,et al. 18F-FDG PET/CT in detecting synchronous primary neoplasms for initial stage of esophageal cancer[J].Journal of Tianjin Medical University,2015,21(04):404.
[2]刘欣,张鹏,陈渊.肠内营养支持在食管癌术后辅助化疗患者中的临床应用[J].天津医科大学学报,2017,23(03):274.
[3]张仲汇,王勇强.肠内营养支持在放化疗食管癌患者中的应用[J].天津医科大学学报,2019,25(03):256.
　ZHAN Zhong-hui,WANG Yong-qiang.Application of enteral nutrition in patients with esophageal cancer after radiotherapy and chemotherapy[J].Journal of Tianjin Medical University,2019,25(04):256.
[4]朱 勇,陈 晶,寇海涛,等.胸腹腔镜食管切除术手术治疗食管癌的临床效果及对患者并发症发生的影响[J].天津医科大学学报,2020,26(01):51.
　ZHU Yong,CHEN Jing,KOU Hai-tao,et al.Clinical effect of thoracic laparoscopic esophagectomy for esophageal cancer and its effect on patient complications[J].Journal of Tianjin Medical University,2020,26(04):51.
[5]张婷玉,胡亚萍,黄晓莹,等.MRI影像与CT影像融合技术在局部晚期食管癌放疗靶区勾画中的应用研究[J].天津医科大学学报,2020,26(04):362.
　ZHANG Ting-yu,HU Ya-ping,HUANG Xiao-ying,et al.Application of MRI and CT image fusion technology in target volume delineation of radiotherapy for local advanced esophageal cancer[J].Journal of Tianjin Medical University,2020,26(04):362.
[6]孙超,余兰,李蓉蓉,等.1990—2019年中国和日本食管癌疾病负担变化趋势的比较分析[J].天津医科大学学报,2024,30(01):46.[doi:10.20135/j.issn.1006-8147.2024.01.0046]
　SUN Chao,YU Lan,LI Rongrong,et al.A comparative analysis of trends in the disease burden of esophageal cancer in China and Japan from 1990 to 2019[J].Journal of Tianjin Medical University,2024,30(04):46.[doi:10.20135/j.issn.1006-8147.2024.01.0046]

备注/Memo

备注/Memo:

作者简介 杜卓然（1989-），男，硕士在读，研究方向：胸心外科学；通信作者：张鹏，E-mail：zhangp.tgh@hotmail.com。

常用功能

更新日期/Last Update: 2015-07-16