CAJ | 학술논문

目的：探讨不同时间乳酸清除率对胃癌 D2/D3根治术术后并发症的预测价值。方法回顾性研究了江汉大学附属医院2008年1月至2013年2月152例胃癌D2/D3根治术后患者，根据有无并发症分为无并发症组和有并发症组。比较两组6h乳酸清除率、正平衡量、体重增加值和24 h乳酸清除率、正平衡量、体重增加值（Δ体重）；判断术后并发症的危险因素及预测价值。结果无并发症组6 h乳酸清除率[（15.1±9.8）%vs.（3.7±2.5）%，P＝0.001]明显高于并发症组，Δ体重值[（4.2±1.2）kg vs.（5.1±1.1）kg，P＝0.015]和正平衡量[（4831.7±372.7）ml vs.（5131.9±303.9） ml，P＝0.008]明显低于并发症组，两组间具有统计学差异。无并发症组24 h 乳酸清除率[（52.1±18.2）%vs.（4.9±3.0）%，P＜0.001]明显高于并发症组，Δ体重值[（0.9±0.3）kg vs.（2.8±0.5） kg，P＜0.001]和正平衡量[（964.5±208.3）ml vs.（2793.1±438.0）ml，P＜0.001]明显低于并发症组，两组间具有统计学差异。多元Logistic回归分析显示：24 h乳酸清除率、6 h乳酸清除率是术后并发症的危险因素。6 h乳酸清除率、24 h乳酸清除率、24 h正平衡量、24 hΔ体重值ROC曲线下面积分别是0.686、0.820、0.616、0.578。结论24 h乳酸清除率可作为预测胃癌D2/D3根治术术后并发症的可靠指标。
목적：탐토불동시간유산청제솔대위암 D2/D3근치술술후병발증적예측개치。방법회고성연구료강한대학부속의원2008년1월지2013년2월152례위암D2/D3근치술후환자，근거유무병발증분위무병발증조화유병발증조。비교량조6h유산청제솔、정평형량、체중증가치화24 h유산청제솔、정평형량、체중증가치（Δ체중）；판단술후병발증적위험인소급예측개치。결과무병발증조6 h유산청제솔[（15.1±9.8）%vs.（3.7±2.5）%，P＝0.001]명현고우병발증조，Δ체중치[（4.2±1.2）kg vs.（5.1±1.1）kg，P＝0.015]화정평형량[（4831.7±372.7）ml vs.（5131.9±303.9） ml，P＝0.008]명현저우병발증조，량조간구유통계학차이。무병발증조24 h 유산청제솔[（52.1±18.2）%vs.（4.9±3.0）%，P＜0.001]명현고우병발증조，Δ체중치[（0.9±0.3）kg vs.（2.8±0.5） kg，P＜0.001]화정평형량[（964.5±208.3）ml vs.（2793.1±438.0）ml，P＜0.001]명현저우병발증조，량조간구유통계학차이。다원Logistic회귀분석현시：24 h유산청제솔、6 h유산청제솔시술후병발증적위험인소。6 h유산청제솔、24 h유산청제솔、24 h정평형량、24 hΔ체중치ROC곡선하면적분별시0.686、0.820、0.616、0.578。결론24 h유산청제솔가작위예측위암D2/D3근치술술후병발증적가고지표。
Objective To analyze the evaluation of lactate clearance rate in complication of patients after D2/D3 radical surgery in gastric carcinoma. Methods From January 2008 to February 2013, the data of 152 patients after D2/D3 radical surgery was studied retrospectively. The patients were divided into one group with compilation and another group without complication. The lactate clearance rate, positive balance fluid volumes, augmented weight were compared between groups after 6, 24 hours in ICU. Risk factors and their value were analyzed. Results 6, 24 hours lactate [(15.1±9.80)% vs. (3.7±2.5)%, P=0.001; (52.1±18.2)% vs. (4.9±3.0)%, P<0.001] in the group without complication significantly increased as compared with the group with complication. However, 6, 24 hours augmented[(4.2±1.2)kg vs. (5.1±1.1)kg, P=0.015; (0.9±0.3)kg vs. (2.8±0.5)kg, P<0.001], positive balance fluid volumes[(4 831.7±372.7)ml vs. (5 131.9±303.9)ml, P=0.008;(964.5±208.3)ml vs. (2 793.1±438.0)ml, P<0.001] in the group without complication strongly lowered as compared with the group with complication. Multivariate logistic regression analysis showed 24 hours lactate clearance rate, positive fluid volumes, augmented weight and 6 hours lactate clearance rate were risk factors after surgery. The area under the curve of the ROC of 6 hours lactate clearance rate, 24 hours lactate clearance rate, positive fluid volumes, augmented weight separately was 0.686,0.820,0.616,0.578. Conclusion 24 hours lactate clearance rate can be regarded as a good and reliable indicator of complication after D2/D3 radical surgery.