The Clinical Analysis Of Risk Factors For Hyperlactatemia Or Lactic Acidosis In Retroperitoneoscopic Surgery

Objective:To investigate the probability of hyperlactatemia or lactic acidosis in patients with retroperitoneoscopic surgery and the risk factors for its occurrence.Methods:A retrospective analysis of patients underwent general anesthesia for retroperitoneoscopic surgery from December 1,2014 to December 31,2016 in the First Hospital of Shanxi Medical University.Collected the clinical data,including gender,age,body mass index(BMI),the grade of the American Society of Anesthesiologists(ASA),laboratory examination results of preoperative(blood routine,liver function,Child-Pugh score,renal function,arterial blood gas analysis and electrolyte),preoperative comorbidities(whether diabetes mellitus,hypertension,anemia is combined),operation type,operation time,monitoring indicators during the operation(arterial blood gas,blood pressure,blood loss and urine volume),intraoperative treatment measures(the type and the amount of infusion and blood products,the application of vasoactive drugs).According to the intraoperative lactate value in arterial blood,the patients were divided into high lactate group and normal lactate group.And a preliminary assessment of the incidence of hyperlactatemia or lactic acidosis in the operation(the ratio of the number of high lactate group to the total number).Then,according to the clinical data of two groups,all data were analyzed by single factor statistical analysis.Logisitic regression model was used to determine the risk factors associated with hyperlactatemia or lactic acidosis in patients with retroperitoneoscopic surgery.Results:Of the 615 patients who underwent retroperitoneoscopic surgery,51 had hyperlactatemia(high lactate group),the probability of occurrence was 8.29%,of which12 cases were lactic acidosis,the probability of occurrence was 1.95%.564 cases did not occur hyperlactatemia or lactic acidosis(normal lactate group).According to single factor analysis,the Child-Pugh score of liver function in high lactate group was higher than that in normal lactate group(P<0.05),the preoperative blood urea and creatinine value were higher than those in normal lactate group(P<0.05),the preoperative blood neutrophil value was higher than normal lactate group(P<0.05).However,there was no significant difference between the two groups in the grade of the American Society of Anesthesiologists,body mass index,and preoperative comorbidities(P>0.05).The operative time and the duration of blood pressure lowered than basic blood pressure twenty percent of high lactate group is longer than normal lactate group(P<0.05),the account of crystal liquid and urine volume of high lactate group is lower than normal lactate group(P<0.05).Multiple factor Logistic regression analysis showed that the high Child-Pugh scorethe high blood creatinine value,the long operative time and the duration of blood pressure lowered than basic blood pressure twenty percent are independent risk factors of hyperlactatemia or lactic acidosis occurred in patients of retroperitoneoscopic surgery(P<0.05).Conclusion:1.Hyperlactatemia or lactic acidosis is a complication with high incidence in retroperitoneoscopic surgery(8.29%)2.The Child-Pugh score,the blood creatinine value,the operative time and the duration of blood pressure lowered than basic blood pressure twenty percent are independent risk factors of hyperlactatemia or lactic acidosis occurred in patients of retroperitoneoscopic surgery.