控制性低中心静脉压用于不同类型肝切除术患者的血液保护效应  

Blood-saving effect of controlled low central venous pressure in different types of hepatectomy

作　　者：魏珂[1] 程波[1] 何开华[1] 闵苏[1] 律峰[1] 

机构地区：[1]重庆医科大学附属第一医院麻醉科, 400016

出　　处：《中华麻醉学杂志》2013年第12期1451-1453,共3页Chinese Journal of Anesthesiology

基　　金：基金项目：重庆市科技攻关计划项目（cstc2012gg-yyjs10058）;国家临床重点专科建设项目补助基金

摘　　要：目的 评价控制性低中心静脉压（CLCVP）用于不同类型肝切除术患者的血液保护效应.方法 择期行肝切除术患者90例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄37～76岁,体重40～75kg.根据手术方式和术中是否实施CLCVP将其分为6组（n=15）：正常CVP的标准肝叶或肝段切除术组、半肝切除术组、不规则肝部分切除术组（NCLCVP1-3组）和CLCVP下标准肝叶或肝段切除术组、半肝切除术组、不规则肝部分切除术组（CLCVP1-3组）.CLCVP1-3组切皮后通过调整体位、限制性输液和静脉输注硝酸甘油等措施维持CVP≤5 cm H2O,同时静脉输注去甲肾上腺素,维持MAP≥60 mm Hg,直至肝切除后.NCLCVP1-3组术中维持CVP6～12 cm H2O.记录术中出血量和输血量.结果 与NCLCVP1-3组比较,CLCVP1-3组出血量均减少（P＜0.05）;与NCLCVP3组比较,CLCVP3组输注红细胞量减少,术中出血量＜ 200 ml的构成比升高,出血量＞1000 ml的构成比降低（P＜0.05）.结论 CLCVP 可减少不同类型肝切除术患者术中出血量,该效应在不规则部分肝切除术中尤为明显.Objective To investigate the blood-saving effect of controlled low central venous pressure （CLCVP） in different types of hepatectomy.Methods Ninety ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 37-76 yr,weighing 40-75 kg,undergoing elective hepatectomy,were divided into 6 groups according to the surgical approach and whether CLCVP was used during surgery （n =15 each）：CLCVP1-3 groups and nonCLCVP1-3 groups （NCLCVP1-3 groups）.The standard hepatectomy,half liver resection and irregular hepatectomy were performed in CLCVP1-3 groups,respectively,with CLCVP.The standard hepatectomy,half liver resection and irregular hepatectomy were performed in NCLCVP1-3 groups,respectively,without CLCVP.In CLCVP1-3 groups,from skin incision to the end of liver resection,CVP was maintained ≤ 5 cm H2 O through adjustment of the position,fluid restriction and iv infusion of nitroglycerin,and norepinephrine was infused simultaneously to maintain mean arterial pressure ≥ 60 mm Hg.In NCLCVP1-3 groups CVP was maintained at 6-12 cm H2O.Intraoperative blood loss and blood transfusion were recorded.Results Compared with NCLCVP1-3 groups,intraoperative blood loss was significantly decreased in CLCVP1-3 groups （P 〈 0.05）.Compared with NCLCVP3 group,the amount of blood transfusion was significantly decreased,the constituent ratio of intraoperative blood loss 〈 200 ml was increased,and the constituent ratio of intraoperative blood loss 〉 1000 ml was decreased in group CLCVP3 （P 〈 0.05）.Conclusion CLCVP can decrease the intraoperative blood loss and blood transfusion in patients undergoing irregular hepatectomy.

关 键 词：降压 控制性 中心静脉压 失血 手术 输血 肝切除术 

分 类 号：R657.3[医药卫生—外科学]