Relavance of peritoneal drainage fluid lactate level in patients with intra-abdominal hypertension

摘要

Objective : The aim of this study was to assess the effect of intra-abdominal hypertension (IAH) on peritoneal fluid lactate, local and systemic organ dysfunctions in patients after major abdominal surgery. Methods : In this prospective study, 26 patients were followed in the surgical intensive care unit. The lactate in peritoneal drainage fluid was analyzed 24?h after surgery concurrently with diuresis, renal FG, APP, creatinine clearance, bilirubin, AST, ALT, prothrombin time, CVP, cardiac index, PaO_(2), BE, arterial pH, arterial lactate, ScvO_(2), FiO_(2)/pO_(2) ratio, oxygen delivery, MAP and APACHE II. In the procedure 1?ml of peritoneal drainage fluid was drawn out from drainage catheter placed in abdominal cavity at the end of the operation. IAH has been defined as a peak intra-abdominal pressure (IAP) value of ≥12?mm Hg, at a minimum, as two standardized measurements obtained 1–6?h apart. Results : There were 16 patients with IAP??12?mm Hg and 10 patients with IAP??12?mm Hg. The mean IAP in groups was 18.02?±?7.00 vs. 8.00?±?1.80?mm Hg, p ??0.05, respectively. There are three major findings: a selective sensitivity of various organs dysfunction to the IAH level; the increase of IAP leads to lactate hyperproduction in abdominal drainage fluid (12.60 vs. 9.90?mmol/L, p ??0.05; and the systemic oxygen delivery was unaltered despite worsening of the local and systemic parameters caused by IAH. Conclusion : The lactate level in peritoneal drainage fluid may be an indicator of intra-abdominal dysfunction in surgical patients with IAH. Clinical monitoring of local lactate production may have a potential predictive and prognostic value.