Clinical significance of normobasemia in early post-operative outcome of hepatic resections.
BACKGROUND
Major hepatic resections are usually followed by acid-base unbalance. Adjustment of the acid-base disorders is considered central when dealing with these critical patients and normobasemia is thought to be a favourable prognostic factor when occurring in the immediate postoperative outcome after major surgery. The present study was undertaken to investigate the influence of acid base balance on the early outcome after hepatic resection.


METHODS
A series of fifty-seven cirrhotic patients was submitted to liver resection for hepatocellular carcinoma. Forty-eight patients experienced an uneventful early postoperative outcome (CTR group). Nine died in the postoperative course (HD group). In all patients pulmonary, renal and hepatic functions were monitored pre- and postoperatively. The pH values were detected daily preoperatively and in the course of the first three days after hepatic resection. In the same days acid base balance and arterial ketone body ratio were assessed on arterial blood samples. Data were collected in a data base and statistical analysis was performed.


RESULTS
A significantly higher metabolic alkalosis was found to characterize the first and second postoperative days (POD1 and POD2) in the CTR group (pH 7.43+/-0.007 vs pH 7.33+/-0.001; pH 7.45+/-0.006 vs pH 7.35+/-0.009; p<0.05). Lower values of pH and an associated impaired energetic status of the liver were found to characterise the postoperative course of the poor prognosis patients. At POD1 AKBR decreased in both groups but while recovering at POD2 in patients of CTR group maintained significantly lower values in HD group (AKBR 1+/-0.3 vs 0.5+/-0.2; p<0.01). A lower energetic status of the liver is associated with an inadequate tricarboxylic acid cycle and is responsible for an impaired production of HCO3-.


CONCLUSIONS
Apparent normobasemia is then expressive of liver failure leading to poor postoperative outcome.
Tocchi
A
A
First Surgical Department, University of Rome La Sapienza, Medical School, Rome, Italy. gluca.costa@iol.it
Mazzoni
G
G
Liotta
G
G
Lepre
L
L
Costa
G
G
Agostini
N
N
Miccini
M
M
D000136:Acid-Base Equilibrium; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000097:blood* / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012016:Reference Values