急性等容血液稀释联合低中心静脉压在肝癌手术中的应用  

Acute normovolemic hemodilution combined with low central venous pressure in liver cancer surgery

作　　者：查本俊[1] 吴志云[1] 邓莎[1] 王永盛[1] 

机构地区：[1]福建省泉州市解放军第180医院麻醉科,362000

出　　处：《临床麻醉学杂志》2013年第1期49-52,共4页Journal of Clinical Anesthesiology

基　　金：福建省泉州市科技计划项目(2011Z34)

摘　　要：目的探讨急性等容血液稀释(ANH)联合低中心静脉压(LCVP)在肝癌手术中的应用价值及安全性。方法拟行右肝癌手术患者66例,ASAⅠ或Ⅱ级,年龄15～65岁,随机均分为三组,ANH+LCVP组、LCVP组和ANH组。患者全麻后行ANH,ANH+LCVP组和LCVP组在肝实质离断过程中将CVP控制在0～5cm H2O,肝实质离断止血彻底后将CVP恢复到7～8cm H2O;ANH组患者在整个手术过程中维持正常的CVP。记录三组患者肝实质离断时间、肝门阻断时间、肝实质横切面积、出血量,记录手术过程中患者的输血量、输液量、尿量以及三组患者术后第1、4、7天ALT、AST、TBIL、BUN和Cr值。结果 ANH+LCVP组和LCVP组肝门阻断时间、肝实质离断时间均明显短于ANH组(P<0.05),在肝实质离断过程中ANH+LCVP组和LCVP组MAP较术前和ANH组明显下降,HR较术前和ANH组明显增快(P<0.05)。肝实质离断过程中ANH组出血量和单位横截面积出血量均明显多于ANH+LCVP组和LCVP组(P<0.05)。ANH组未输异体血液比例明显低于ANH+LCVP组和LCVP组(P<0.05)。三组患者术毕Hb值均明显低于术前(P<0.05),术后第1、4、7天三组ALT、AST均明显高于术前(P<0.05)。结论在肝癌手术中联合应用急性等容血液稀释和低中心静脉压技术,可减少手术中异体输血,且对肝肾功能无明显影响。Objective To detect the safety and efficacy of acute normovolemic hemodilution （ANH） with Low central venous pressure（LCVP） on liver cancer surgery. Methods Sixty six ASA Ⅰ or Ⅱ class patients undergoing liver cancer surgeries were randomly divide into group ANH＋ LCVP, group LCVP, and group ANH. CVP was controlled 0-5 cm H2O during liver resection and recovered to 7-8 cm H2 O after complete hemostasis in group ANH＋LCVP and group LCVP. Group ANH maintained a normal CVP throughout the surgery. The time of hepatic parenehymal transection, the occluding time of hepatic portal, and the cross section area of liver, the bleeding volume, blood transfusion, infused fluid volume, urine output during operation, liver and renal function on 1,4,7 d after operation were recorded. Results The occluding time of hepatic portal, the time of hepatic parenchymal transection in group ANH＋LCVP and group LCVP were obviously less than those in group ANH （P 〈 0. 05）. MAP in group ANH ＋ LCVP and group LCVP were significantly lower than pre-operation and group ANH, while HR were faster （P〈0. 05）. Compared with group ANH＋LCVP and group LCVP, the total and unit cross-section area bleeding volume in group ANH were obviously increased （P〈0. 05）. The ratio of non-transfusion in group ANH were obviously less than those in the other two groups （P〈0.05）. Hb among the three groups at the ending of operation were all lower than pre-operation, and the ALT, AST at 1, 4, 7 d after the operation were significantly increased in three groups （P〈0. 05）. Conclusion Acute normovolemie hemodilution combined with low central venous pressure can reduce transfusion in liver cancer surgery without any significant effect on liver and renal function.

关 键 词：急性等容血液稀释 低中心静脉压 异体输血 肝叶切除 

分 类 号：R614[医药卫生—麻醉学]