Arterial blood ketone body ratios during partial hepatectomy in relation to major postoperative complications.

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Ozawa et al showed arterial blood ketone body ratio (acetoacetate/β-hydroxybutyrate, AKBR) reflects the mitachandrial free NAD+/NADH ratio which is coupled with mitochondrial oxidative phosphorylation. In the study, changes in the AKBR during 27 hepatectomies were examined in relation to major post-operative complications involving hepatic failure. Concentrations of arterial blood ketone bodies, acetoacetate and β-hydroxybutyrate, were determined at least three times during the operation, i.e, at laparotomy (phase I), during hepatectomy (phase II), and immediately after operation (phase III), according to the standard method reported by Williamson. AKBR of all 22 patients varied from minimal level 0.22 to maximal 10.8 in phase I, decreased with the progress of procedures, and returned to normal range (over 0.7) in phase III except in 5 cases. Four patients out of the 5 patients with low levels of AKBR in phase III died of severe hepatic failure. The other cases whose AKBR returned to normal range in phase III did not show any complications. The measurement of AKBR during partial hepatectmy is of major importance in the prognostic evaluation of a postoperative risk.
社団法人日本肝臓学会の論文