控制性低中心静脉压在肝叶切除术中对胃黏膜pH值的影响  

Effect of Controlled Low Central Venous Pressure on Intramucosal ph Undergoing Hepatic Lobectomy

作　　者：冯丹凤[1] 万震威[1] 李长科[1] 丘宇[1] 

机构地区：[1]汕头大学附属粤北人民医院麻醉科,广东韶关512026

出　　处：《中国医药指南》2012年第33期28-30,共3页Guide of China Medicine

摘　　要：目的通过监测使用控制性低中心静脉压技术期间患者胃黏膜pH值的变化,评估控制性低中心静脉压技术对组织血液灌流和氧合情况的影响。方法 60例择期全麻下行肝叶切除术患者,随机均分为CLCVP组(L组)和对照组(C组)。L组患者在肝叶完全切除前将CVP控制在0～4cmH2O,随后通过输液将CVP升至6～12cmH2O。C组CVP维持在6cmH2O～12cmH2O。比较两组患者术中失血量、输血率、输血量、尿量、手术时间及在术前(T0)、肝叶切除时(T1)、恢复容量时(T2)和手术结束时(T3)胃黏膜pH值。结果两组患者胃黏膜pH值在术前(T0)、肝叶切除时(T1)、恢复容量时(T2)和手术结束时(T3)均>7.35,相同时点的胃黏膜pH值组间比较差异均无统计学意义(P>0.05);出血量、输血量及输血率组间比较差异有统计学意义(P<0.05),L组明显少于C组,手术时间、尿量差异则无统计学意义。结论在肝叶切除术中,控制性低中心静脉压技术不但减少了术中出血量及输血量而且可以保证患者全身重要器官的组织灌流和氧合。Objective To evaluate the effect of controlled low central venous pressure on the tissues perfusion and the oxygen balance through monitoring the change of intramucosal ph in patients undergoing hepatic lobectomy.Methods Sixty patients were divided into two groups of CLCVP group（L） and control group（C）.The CVP was maintained at 0cmH2O～4cmH2O by withholding of intravenous fluids and maintained at 6 cmH2O～12 cmH2O by fluid resuscitation after hepaticlobectomy in group L,which was maintained at 6 cmH2O～12 cmH2O all the time by normal transfusion in group C.The blood loss and blood transfusion and urinary volume were compared in the two groups.The intramucosal ph was compared just before preoperative（T0）,lobectomy of liver（T1）,fluid resuscitation（T2） and at the end of surgical procedure（T3）.Results The intramucosal ph was all greater than 7.35 and was no statistically significant difference at T0,T1,T2 and T3 between the two groups（P0.05）.The volume of blood loss and amount of transfusion were significantly lower in the CLCVP group than in the control group,5 patients in the CLCVP group had a blood transfusion mean（220.0±44.7） ml and 19 patients in the control group mean（505.3±367.4） ml,and there was statistically significant difference between the two groups（P0.01）.There was no significant difference in operating time and urinary volume between the two groups（P0.05）.Conclusion Controlled low central venous pressure was not only reduced the blood loss and blood transfusion but also do not disturb the tissues perfusion and the oxygen balance during hepatic lobectomy.

关 键 词：胃黏膜PH值 低中心静脉压 肝叶切除术 

分 类 号：R614.23[医药卫生—麻醉学]