急性等容血液稀释联合控制性低中心静脉压在高原肝包虫肝叶切除术中的应用  

Application of acute normovolemic hemodilution combined with controlled low central venous pressure in hepatectomy of hydatid hepatis on plateaus

作　　者：龚华渠 杨淋 巩固 庄雁波 韩生财 GONG Huaqu;YANG Lin;GONG Gu;ZHUANG Yanbo;HAN Shengcai(Department of Anesthesiology,General Hospital of Western Theater Command,Chengdu 610083,China;Department of Anesthesiology,People's Hospital of Guoluozhou,Guoluozhou 81400,China;Department of Anesthesiology,Jiuzhi County People’s Hospital,Jiuzhi 81400,China)

机构地区：[1]西部战区总医院麻醉科,成都610083 [2]青海省果洛洲人民医院麻醉科,814000 [3]青海省久治县人民医院麻醉科,814000

出　　处：《武警医学》2022年第10期853-856,共4页Medical Journal of the Chinese People's Armed Police Force

基　　金：2021度院管课题2021-XZYG-A10

摘　　要：目的 观察急性等容血液稀释(ANH)联合控制性低中心静脉压(CLCVP)在高原肝包虫切除术中的应用。方法 选取青海省果洛州人民医院及久治县人民医院2020年5-12月拟行肝包虫肝叶切除术患者46例,按是否行ANH+CLCVP分为AB两组。A组全麻后先进行ANH,然后进行低中心静脉压(LCVP)控制,在肝门阻断前中心静脉压(CVP)控制在0~5 cmH_(2)O,止血彻底后将CVP恢复至8~12 cmH_(2)O;B组行常规手术治疗,不进行ANH,CVP维持在8~12 cmH_(2)O。分别记录入室(T_(1))、ANH后5 min(T_(2)),LCVP后30 min(T_(3)),术毕(T_(4))各时点血液动力学指标的变化;记录两组术中出血量、异体输血量及例数;记录两组术前、术毕即刻、术后24 h肾功能改变;观察患者术后康复情况。结果 T_(3)时A组MAP较B组降低,而心率高于B组,差异有统计学意义(P<0.05)。B组术中出血量、异体输血量及例数明显高于A组,差异有统计学意义(P<0.05);A组较B组肛门排气、排便早,下床活动时间缩短,住院时间明显减少(P<0.05);各时相点两组肾功能正常且差异无统计学意义。结论 ANH联合CLCVP可以安全用于高原肝包虫肝叶切除术,能够明显减少异体输血量,促进术后康复,值得临床借鉴。Objective To observe the application of acute normovolemic hemodiluti(ANH) combined with controlled low central venous pressure(CLCVP) on plateau liver hydatid excision.Methods A total of 46 patients with hepatic hydatid were selected from Guoluozhou and Jiuzhi People’s Hospital of Qinghai Province from May to December 2020 to undergo hepatic lobotomy for hepatic hydatid. They were randomly divided into two groups according to whether ANH+CLCVP was performed. For the ANH+CLCVP(A) group, ANH was performed after general anesthesia, then LCVP was controlled, and CVP was controlled within 0~5 cmH_(2)O before hilar occlusion, CVP was restored to 8-12 cmH_(2)O after complete hemostasis;Neither ANH nor CLCVP were performed in group B, whose CVP were maintained at 8-12 cmH_(2)O.The changes of Hemody—allogeneic blood transfusion in the two groups were recorded. Changes in renal function of the two groups were recorded before, immediately after and 24 h after surgery. The postoperative recovery of the patients was observed.Results MAP of group A was lower than that of group B, while HR was higher than that of group B at T3(P<0.05).The amount of intraoperative blood loss, allogeneic transfusion and the number of cases in group B were more than that of group A, group A had earlier anal exhaust and defecation, shorter activity time out of bed, and significantly shorter hospitalization time than that of group B(P<0.05).The renal function of the two groups at each time point was normal and no significant difference was found(P>0.05).Conclusions Acute normovolemic hemodilution combined with controlled low central venous pressure can be safely used for liver lobectomy in patients with hydatid hepatica on plateau, can significantly reduce the amount of allogeneic blood transfusion, and promote postoperative recovery of patients without side effect, which is worthy of clinical reference.

关 键 词：急性等容性血液稀释 控制性低中心静脉压 血液保护 肝叶切除 高原 

分 类 号：R657.3[医药卫生—外科学]