急性等容血液稀释并LCVP对肝叶切除术患者小肠氧代谢的影响  

作　　者：张崧[1] 沈华春[2] 吴胜东[1] 潘志浩[1] 杜金满[1] 

机构地区：[1]宁波大学医学院附属李惠利医院,315040 [2]浙江省宁波市第二医院,315040

出　　处：《浙江临床医学》2015年第1期28-29,共2页Zhejiang Clinical Medical Journal

基　　金：浙江省宁波市科技局项目（2010C50028）;浙江省宁波市医学科技基金项目（2010A01）

摘　　要：目的探讨急性等容血液稀释（ANH）联合控制性低中心静脉压（LCVP）对肝叶切除术患者小肠氧代谢的影响。方法择期行肝叶切除手术患者40倒，ASAI级或Ⅱ级，年龄60-71岁。体重指数18-28kg／m^2。随机分为2组（n=20）：对照组（Ⅰ组）、ANH联合LCVP组（Ⅱ组）。分别于入手术室后（T0）、ANH完成后30min（T1）、肝实质完全离断即刻（T2）、关腹前（T3）取小肠动脉和肠系膜上静脉血样，进行血气分析，测定乳酸Lac、Hb、Hct，动脉氧饱和度（SaO2），以及肠系膜静脉血氧饱和度（SvmO2），计算动脉血氧含量（CaO2）、静脉血氧含量（CvmO2）、肠动静脉氧含量差（Da-vmO2）、氧摄取率（ERO2）和肠系膜上静脉．动脉乳酸盐浓度差（Dvm—aBL）。结果与TO比较，T2、T3时两组Hb、Hct值均明显降低（P〈0．05）；与Ⅰ组比较，Ⅱ组T1时Hb、Hct值明显降低，而T3时明显升高（P〈0．05）。两组SvmO2、ERO2、Da-vmO2在不同时间点虽有不同程度变化，但均在正常值范围内，两组及组间各时间点Dvm-aBL值差异无统计学意义（P〈0．05）。结论适度血液稀释联合控制性低中心静脉压对肝叶切除术患者小肠氧代谢无明显影响。Objective To investigate the effect of acute normovolemic hemodilution （ NH ） combined with controlled low central venous pressure （ LCVP ） on intestine oxygen metabolism in patients undergoing hepatic resection. Methods Forty ASA ] or Ⅱ patients, aged 60-71 yr, body mass index （ 18-28 ） kg/m^2, scheduled for hepatic resection, were randomly divided into 2 groups （ n=20 each ） ： control group （ group Ⅰ ） and ANH combined with LCVP group （ group Ⅱ ） . The blood samples were taken from arteria intestinales and vena mesenterica superior vein for determination of the index of intestine oxygen metabolim, such as Lac, Hb, Hct, SaO2, SvmO2, CaO2, CvmO2, Da-vmO2, ERO2 and Dvm-aBL were recorded at the time of patients getting into the operation room （ TO ） , 30 min after ANH （ T1 ） , the time of hepatic parenchymal completely amputated （ T2 ） and the time before the abdomen closed, respectively. Results Compared with T0, Hb and Hct significantly decreased （ P〈0.05 ） in both groups. Compared with Ⅰ , Hb and Hct significantly decreased （ P〈0.05 ） at T1 and significantly increased （ P〈0.05 ） at T3 ; SvmO2, ERO2, Da-vmO2 were normal, there was no difference in both groups and between the two groups at any time for Dvm-aBL （P〈0.05） .Conclusion There was no significant adverse effects on small intestine oxygen metabolism for the patients undergoing hepatic resection when moderate ANH combined with LCVP used correctly.

关 键 词：急性等容血液稀释 低中心静脉压 肝叶切除术 肠氧代谢 

分 类 号：R457.1[医药卫生—治疗学]