中文摘要：

目的 探讨引起胃肠道手术患者术后动脉血乳酸（Lac）升高的危险因素.方法 回顾性分析宁夏医科大学总医院2013年11月至2014年11月实施胃肠道手术后转入重症加强治疗病房（ICU）的216例患者的临床资料,依据术后初始Lac水平分为Lac升高组（Lac ＞2 mmol/L,100例）和Lac正常组（Lac≤2 mmol/L,1 16例）.记录两组患者的相关资料：①基线资料：性别、年龄、术前急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、基础疾病、术后初始Lac;②术前危险因素：24h补液总量、24 h补胶体量;③术中危险因素：是否行急诊手术、手术时间、手术部位、抗菌药物使用、平均动脉压最高值、最低值及其差值（MAPmax、MAPmin、△MAP）、补液总量、补胶体量.采用多元线性回归分析筛选出影响胃肠道手术患者术后Lac水平的危险因素.结果 ①两组患者性别、年龄、术前APACHEⅡ评分以及基础疾病等基线资料比较差异均无统计学意义（均P＞0.05）;Lac升高组初始Lac水平明显高于Lac正常组（mmol/L：5.1±3.6比1.3±0.4,t=10.584,P=0.000）.②两组患者术前24 h补液总量、补胶体量和术中MAPmax均无明显差异.与Lac正常组比较,Lac升高组术中△MAP[mmHg（1 mmHg=0.133 kPa）：35.8±14.4比28.7±13.7,t=3.727,P=0.000]、急诊手术比例（19.0％比9.5％,x 2=9.869,P=0.007）、术中补液总量[mL：4 500（3 500,5 800）比3 700（2 812,5 075）,Z=-3.244,P=0.001]、术中补胶体量[mL：1 000（1 000,1 900）比1 000（1 000,1 787）,Z=-2.347,P=0.019]均明显升高,手术时间明显延长（min：222.0±91.5比187.0±75.9,t=3.026,P=0.003）;而术中MAPmin（mmHg：68.7±11.6比75.9±10.6,t=-4.716, P=0.000）和抗菌药物使用率（62.0％比86.2％,x2=18.318,P=0.000）均明显降低.③食管、胃、十二指肠及小肠、大肠手术患者分别占6.9％、22.7％、16.7％、53.7％,术后Lac分别为2.8（1.6,5.4）、2.3（1.2,5.8）、2.5（1.5,5.2）、1

英文摘要：

Objective To investigate the risk factors that cause arterial blood lactate （Lac） elevation in patients after gastrointestinal operation.Methods The data of 216 patients who had undergone gastrointestinal operation, and transferred to intensive care unit （ICU） of Ningxia Medical University General Hospital from November 2013 to November 2014 were retrospectively analyzed.According to the initial level of blood Lac after operation,the patients were divided into two groups： high Lac group （Lac 〉 2 mmol/L, n =100） and normal Lac group （Lac ≤ 2 mmol/L, n =116）.The baseline data of two groups were recorded as follows： ① baseline data： gender, age, preoperative acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score, previous diseases, initial Lac level after operation;② preoperative risk factors： 24-hour total amount of fluid, and the amount of colloid for resuscitation;③ intraoperative risk factors： the proportion of emergency operation, operation time, site of operation, usage of antibacterial drug, the highest and lowest mean arterial pressure and its difference （MAPmax, MAPmin, A MAP）,total amount of fluid and colloid for resuscitation.The risk factors of increasing Lac post gastrointestinal operation was evaluated using multiple linear regression analysis.Results ① There were no significant differences in baseline data such as gender, age, preoperative APACHE Ⅱ score and previous diseases between the two groups （all P 〉 0.05）.Initial Lac level in high Lac group was significantly higher than that of normal Lac group （mmol/L： 5.1 ± 3.6 vs.1.3 ±0.4,t =10.584,/P =0.000）.② There were no significant differences in 24-hour amount of fluid and colloid for resuscitation before operation, and intraoperative MAPmax between two groups.Compared with normal Lac group, intraoperative A MAP [mmHg （1 mmHg =0.133 kPa）： 35.8 ± 14.4 vs.28.7 ± 13.7, t =3.727, P =0.000], the proportion of emergency operations （19.0% vs.9.5%, x 2 =9.869, P =0.007）