ORIGINAL ARTICLES   

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

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.