急性等容血液稀释联合低中心静脉压对肝癌手术脑氧代谢的影响  

The effect of acute normovolemic hemodilution with low central venous pressure on cerebral oxygen metabolism in hepatocellular carcinoma operation

作　　者：查本俊[1] 吴志云[1] 熊华平[1] 张海华[1] 

机构地区：[1]解放军第180医院麻醉科,福建省泉州市362000

出　　处：《临床麻醉学杂志》2013年第5期454-457,共4页Journal of Clinical Anesthesiology

基　　金：福建省泉州市科技计划项目(2011Z34)

摘　　要：目的观察急性等容血液稀释(ANH)联合低中心静脉压(LCVP)在肝癌手术中对患者脑氧代谢的影响。方法拟行肝癌手术患者40例,随机均分为两组。ANH+LCVP组全麻后先进行ANH,然后进行LCVP控制,在肝脏实质完全离断前CVP控制在0～5cmH2O,肝实质切除止血彻底后将CVP恢复至7～8cmH2O;常规治疗组手术中CVP维持在7～8cmH2O。分别于入室后(T0)、采血后5min(T1)、肝癌切除后5min(T2)、恢复容量后5min(T3)抽取动脉、颈内静脉球部的血作血气分析,检测动脉、颈内静脉血氧饱和度(SaO2、SjvO2)、动脉、颈内静脉血氧分压(PaO2、PjvO2)、Hb和Hct,并计算动脉、颈内静脉球部血氧含量(CaO2、CjvO2)、脑氧摄取率(CERO2)、动脉、颈内静脉球部血氧含量差(Da-jvO2)和乳酸差(VADL)。结果与T0时比较,T2、T3时两组Hb、Hct值明显降低(P<0.05),T1～T3时ANH+LCVP组SjvO2明显升高(P<0.05),CERO2、Da-jvO2明显降低(P<0.05),T2、T3时常规治疗组CERO2、Da-jvO2明显降低(P<0.05)。与T2时比较,T3时ANH+LCVP组Hb、Hct值明显升高(P<0.05),常规治疗组明显下降(P<0.05)。与常规治疗组比较,ANH+LCVP组T1、T2时Hb、Hct值明显降低、而T3时明显升高(P<0.05),T1～T3时SjvO2、T3时Da-jvO2明显升高(P<0.05);而T1时Da-jvO2明显降低(P<0.05)。结论急性等容血液稀释联合低中心静脉压技术可以安全应用于肝癌手术中,对脑氧代谢无明显不良影响。Objective To observe the safety and effect of acute normovolemic hemodilution （ANH） with low central venous pressure （LCVP） on cerebral oxygen metabolism in hepatocellular carcinoma operation. Methods Forty patients who accept hepatocellular carcinoma operation were randomly divided into two groups, in group ANH ＋ LCVP ANH after general anesthesia, control LCVP 0 5 cm H20 before resection of the liver, and increase CVP to 7-8 cm H20 after parenchyma resection and stanching bleeding, in conventional treatment group CVP was maintained 7-8 cm H20 during surgery. Respectively the time patients getting into the operation room（T0）, 5 rain after blood collection （T1）, 5 rain after hepatectomy（T2 ）, 5 min after recovery capacity（T3 ） was recorded. To draw blood from the artery and the ball portion of the internal jugular vein for blood gas analysis detecting arterial and venous oxygen saturation （ SaO2, SjvO2 ）, arterial and venous blood oxygen partial pressure （PaO2, PjvO2 ）, Hb and Hct. Calculate oxygen content of arterial and the ball portion of the internal jugular vein （CaO2 ,CjvO2 ）, cerebral oxygen uptake rate （CERO2）, the arterial internal jugular vein hnlbar oxygen difference（Da-jvO2 ）and lactate difference Results Compared with To, in group ANH＋ LCVP SjvO2 significantly increased （P〈0. 05） from Tx to T3 , while CERO2 and Da-jvO2 significantly decreased （P〈 0. 05） ;in conventional group at Tz and T3, CEROz and Da-jvO2 significantly decreased（P〈0. 05）. In group ANH＋LCVP, SjvO2 from T~ to T~ and Da-jvOz at T3 are significantly higher than the conventional group （P〈0. 05）. Conclusion The technology of combing acute normovolemic hemodilution with low central venous pressure can be used on hepatocellular carcinoma operation, no significant adverse effects on cerebral oxygen metabolism was noticed.

关 键 词：急性等容血液稀释 低中心静脉压 脑氧代谢 肝癌 

分 类 号：R614[医药卫生—麻醉学]