Analysis Of Risk Factors For Hyperlactatemia In Retroperitoneoscopic Surgery

Objective:To study the incidence of hyperlactatemia in patients undergoing retroperitoneoscopic surgery and to analyze the clinical risk factors.Methods:The patients who underwent retroperitoneoscopic surgery in the First Hospital of Shanxi Medical University from January 1,2018 to June 30,2019 were enrolled.Collected the general date: age,gender,height,weight,underlying diseases combined,drug history of biguanide;Preoperative laboratory examination: serum Hb concentration,serum urea concentration,serum creatinine concentration,the liver Child-Pugh score;Intraoperative data:operation type,duration of operation,duration of pneumoperitoneum,intraoperative urine volume,blood loss,total fluid intake,type of fluid,intraoperative persistent hypotension,use of vasoactive drugs,propofol dosage,blood lactate concentration,bladder pressure.The patients were divided into high lactate group and normal lactate group according to the lactate value during the operation.The incidence of intraoperative hyperlactatemia was preliminarily evaluated.A 1 ? 4 matched case-control study was conducted to explore risk factors according to age and sex.To analyze the relevant date by univariate analysis,then multivariate Logistic regression analysis was conducted for the indicators with statistically significant differences,to determine the independent risk factors of hyperlactatemia during retroperitoneoscopic surgery.Results:Among 726 patients,76(10.5%)cases lactate value increased,of which 8(1.2%)cases were lactic acidosis.650 cases did not occur hyperlactatemia or lactic acidosis,304 cases in the normal lactate group according to the ratio of 1:4.Univariate analysis showed that the liver Child-Pugh score,serum creatinine concentration,BMI,duration of operation and pneumoperitoneum,bladder pressure during the pneumoperitoneum,occurrence of prolonged hypotension and the cases of pheochromocytoma resection in the high lactate group were higher than those in the normal lactate group,the urine volume was lower,with statistically signficant differences(P < 0.05).Multivariate Logistic regression analysis showed that the liver Child-Pugh score(OR = 9.776,95%CI 4.689~20.383,P <0.001),the serum creatinine concentration(OR = 1.134,95%CI 1.083~1.189,P < 0.001),the duration of pneumoperitoneum(OR = 1.021,95%CI 1.001 ~ 1.042,P = 0.043),pheochromocytoma resection(OR = 5.146,95%CI 1.229~21.543,P = 0.025),prolonged hypotension(OR = 12.956,95%CI 2.028~82.753,P = 0.007)were the independent risk factors of hyperlactatemia for retroperitoneoscopic surgery.Conclusion:The incidence of hyperlactemia in retroperitoneoscopic surgery is 10.5%.The preoperetive liver Child-Pugh score,serum creatinine concentration,pneumoperitoneum duration,pheochromocytoma resection and prolonged hypotension are the independent risk factors of hyperlactatemia in retroperitoneoscopic surgery.