中晚期肝癌患者肝门阻断血流动力学和动脉血气变化  

The Changes of Hemodynamics and Arterial Blood Gas in Advanced Hepatocellular Carcinoma Patients with Occlusion of Hepatic Blood Inflow

作　　者：赵德芳[1] 

机构地区：[1]内蒙古医科大学附属医院普通外科,呼和浩特010059

出　　处：《医学综述》2014年第21期3978-3979,共2页Medical Recapitulate

基　　金：内蒙古教育厅基金支持(NJ10142)

摘　　要：目的考察中晚期肝癌患者行入肝血流阻断术的血流动力学和动脉血气变化。方法收集2009年5月至2012年2月内蒙古医科大学附属医院收治确诊的中晚期肝病患者36例,均行择期肝叶切除术。比较肝门阻断前,阻断1、5、10、20 min和最终解除阻断后30 min血流动力学指标及肝门阻断前、阻断20 min和最终解除阻断后30 min后的动脉血气分析指标。结果与阻断前比,心脏指数、中心静脉压随着阻断时间延长变化不显著(P>0.05);心率随着阻断时间延长而增高(P<0.05),平均动脉血压和心排血量降低(P<0.05),解除阻断30 min所有血流动力学指标恢复至阻断前(P>0.05)。与阻断前比,阻断20 min,pH、动脉血氧分压、动脉CO2分压和碱剩余降低(P<0.05),解除阻断30 min所有气血指标恢复至阻断前水平(P>0.05)。结论中晚期肝癌患者采用肝门阻断的方法行肝切除术安全,可靠。Objective To examine the effect of occlusion of hepatic blood inflow on hemodynamics and arterial blood gas in advanced hepatocellular carcinoma patients. Methods A total of 36 cases of advanced hepatocellular carcinoma patients admitted to the Affiliated Hospital of Inner Mongolia Medical College from May 2009 to Feb. 2012 were included in the study,all of which were treated by hepatolobectomy. Hemodynamic and arterial blood gas were compared before operation and 1,5,10,20 and 30 minutes after hepatic portal intermittent blocking. Results Compared with the pre-oeclusion, the cardiac index （CI）, central venous pressure（CVP） did not change significantly after occlusion（ P 〉 0.05 ）. Heart rate（HR） increased as occlusion time increase（ P 〈 0.05 ） , mean artery pressure （MAP） and cardiac output （ CO ） decreased （ P 〈0.05）. But CI, CVP, HR, MAP and CO turned into normal 30 minutes after occlusion was free（P 〉0.05）. Compared with the pre-ocelusion, pH, PaO2 and BE decreased （ P 〈 0.05 ） after occlusion. But pH, PaO2, PaCO2 and BE turned into normal 30 minutes after occlusion was free （ P 〉 0.05 ）. Conclusion The application of occlusion of hepatic blood inflow in patients with advanced hepatoeellular carcinoma is safe, and reliable.

关 键 词：中晚期肝癌 肝门阻断 血流动力学 动脉血气 

分 类 号：R657.3[医药卫生—外科学]