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Panminerva Medica 2001 June;43(2):81-4

lingua: Inglese

Clinical significance of normobasemia in early post-operative outcome of hepatic resections

Tocchi A., Mazzoni G., Liotta G., Lepre L., Costa G., Agostini N., Miccini M.

From the ­First Sur­gi­cal Depart­ment Uni­ver­sity of ­Rome “La Sapien­za” Med­i­cal ­School, ­Rome, Italy


Back­ground. ­Major hepat­ic resec­tions are usu­al­ly fol­lowed by ­acid-­base unbal­ance. Adjust­ment of the ­acid-­base dis­or­ders is con­sid­ered cen­tral ­when deal­ing ­with ­these crit­i­cal ­patients and nor­mob­a­se­mia is ­thought to be a favour­able prog­nos­tic fac­tor ­when occur­ring in the imme­di­ate post­op­er­a­tive out­come ­after ­major sur­gery. The ­present ­study was under­tak­en to inves­ti­gate the influ­ence of ­acid ­base bal­ance on the ear­ly out­come ­after hepat­ic resec­tion.
Meth­ods. A ­series of fif­ty-sev­en cir­rhot­ic ­patients was sub­mit­ted to liv­er resec­tion for hepat­o­cel­lu­lar car­ci­no­ma. For­ty-­eight ­patients expe­ri­enced an unevent­ful ear­ly post­op­er­a­tive out­come (CTR ­group). ­Nine ­died in the post­op­er­a­tive ­course (HD ­group). In all ­patients pul­mo­nary, ­renal and hepat­ic func­tions ­were mon­i­tored pre- and post­op­er­a­tive­ly. The pH val­ues ­were detect­ed dai­ly pre­op­er­a­tive­ly and in the ­course of the ­first ­three ­days ­after hepat­ic resec­tion. In the ­same ­days ­acid ­base bal­ance and arte­ri­al ­ketone ­body ­ratio ­were ­assessed on arte­ri­al ­blood sam­ples. ­Data ­were col­lect­ed in a ­data ­base and sta­tis­ti­cal anal­y­sis was per­formed.
­Results. A sig­nif­i­cant­ly high­er meta­bol­ic alka­lo­sis was ­found to char­ac­ter­ize the ­first and sec­ond post­op­er­a­tive ­days (POD1 and POD2) in the CTR ­group (pH 7.43±0.007 vs pH 7.33±0.001; pH 7.45±0.006 vs pH 7.35±0.009; p<0.05). Low­er val­ues of pH and an asso­ciat­ed ­impaired ener­get­ic stat­us of the liv­er ­were ­found to char­ac­ter­ise the post­op­er­a­tive ­course of the ­poor prog­no­sis ­patients. At POD1 ­AKBR ­decreased in ­both ­groups but ­while recov­er­ing at POD2 in ­patients of CTR ­group main­tained sig­nif­i­cant­ly low­er val­ues in HD ­group (­AKBR 1±0.3 vs 0.5±0.2; p<0.01).
A low­er ener­get­ic stat­us of the liv­er is asso­ciat­ed ­with an inad­e­quate tri­car­box­yl­ic ­acid ­cycle and is respon­sible for an ­impaired pro­duc­tion of HCO3-.
Con­clu­sions. Appar­ent nor­mob­a­se­mia is ­then expres­sive of liv­er fail­ure lead­ing to ­poor post­op­er­a­tive out­come.

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