Abstract
The acid-base balance from the postoperative day (POD) 1 to POD 3 after cirrhotic liver resection was investigated in relation to operative outcome by conducting a retrospective study on the changes in arterial ketone body ratio (AKBR), which reflects the hepatic mitochondrial redox state, and arterial blood gas analysis. Patients were grouped according to their outcome: hospital death (HD) and or good outcome, the latter group acting as controls (CTR). Metabolic alkalosis developed in a significant number of the CTR patients (p<0.01), who had high AKBR values. By contrast, metabolic alkalosis did not develop in the HD group, with significantly lower AKBR (p<0.001), and there was almost normobasemia. There were no significant differences in the need for mechanical respiratory assistance, the amounts of fresh frozen plasma administered, and renal function test results between the two groups on each of 3 postoperative days. These data indicated that the absence of metabolic alkalosis during the early postoperative days reflects disruption of energy metabolism in the remnant liver, and that the apparent normobasemia is a significant indicator of poor prognosis after cirrhotic liver resection.
Résumé
Pour évaluer l'évolution postopératoire des patients cirrhotiques ayant eu une résection du foie, l'équilibre acidobasique du premier au troisième jours postopératoiresa été comparé rétrospectivement aux taux des corps cétoniques artériels (CCA), témoins de l'état redox mitochondrial des cellules hépatiques. Les patients ont été divisés en deux groupes selon qu'ils sont décédés (DH) ou pas (control = C) en milieu hospitalier. Dans le groupe DH, où les taux de CCA étaient plus bas (p<0.001), l'alcalose métabolique ne s'est pas développée et ces patients sont restés en équilibre acidobasique. Dans le groupe C, qui avait des taux plus élevés de CCA, une alcalose métabolique s'est développée plus souvent (p<0.01). A chaque journée postopératoire, il n'y avait aucune différence significative entre les deux groupes en ce qui concerne la nécessité d'assistance respiratoire mécanique, la quantité de plasma frais transfusée et la qualité de fonction rénale. Ces résultats indiquent que l'absence d'alcalose métabolique dans l'évolution postopératoire immédiate est le témoin d'un déséquilibre du métabolisme énergétique du foie restant et que l'apparente normobasie est en fait un indicateur significatif d'un mauvais pronostic après résection hépatique chez le cirrhotique.
Resumen
Se investigó el estado del balance ácido-base apartir del primer día postoperatorío (DPO 1) hasta el DPO 3 luego de resección de hígado cirrótico, en relación con el resultado operatorio por medio de un estudio retrospectivo sobre los cambios en la relación de los cuerpos cetónicos arteriales (RCCA), la cual refleja el estado redox mitocondrial, y el análisis de los gases arteriales. Los pacientes fueron divididos en dos grupos: patientes muertos en el hospital (MH) y pacientes del grupo control, aquellos que tuvieron buen resultado (CTR). En el grupo CTR, con altos valores de RCCA, se desarrolló alcalosis metabólica en forma significativa (p<0.01). El grupo MH, en contraste, con valores de RCCA significativamente menores, no desarrolló alcalosis metabólica, y demostró casi normobasemia. La frecuencia de asistencia respiratoria mecánica, la cantidad de plasma fresco administrado y las pruebas de función renal no mostraron diferencias significativas entre los dos grupos en cada DPO. Estos datos indican que la ausencia de alcalosis metábolica durante los primeros días postoperatios refleja la alteración del metabolismo energético en el hígado residual y que la aparente normobasemia es de real significación clínica como indicador de mal pronóstico luego de una resección de hígado cirrótico.
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Wada, Y., Mori, K., Sugano, M. et al. Apparent normobasemia as a negative prognostic sign immediately after hepatectomy. World J. Surg. 17, 116–120 (1993). https://doi.org/10.1007/BF01655722
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DOI: https://doi.org/10.1007/BF01655722