控制性低中心静脉压联合肝血流阻断在肝癌切除术中的应用  

Application of controlled low central venous pressure combined with hepatic blood occlusion in hepatectomy

作　　者：赵洪伟[1] 王寅雪[1] 张霄蓓[1] 李越[1] 李锦成[1] 

机构地区：[1]天津医科大学肿瘤医院麻醉科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市300060

出　　处：《中国肿瘤临床》2015年第24期1174-1177,共4页Chinese Journal of Clinical Oncology

摘　　要：目的：观察控制性低中心静脉压（controlled low central venous pressure, CLCVP）联合肝血流阻断对肝切除术中出血及血流动力学变化的影响。方法：选取天津医科大学肿瘤医院2014年6月至2014年12月60例肝叶煅切除术患者，随机分成肝血流阻断组（Ⅰ组）和肝血流阻断联合CLCVP组（Ⅱ组）。Ⅰ组在肝切除过程中只应用肝血流阻断技术，采用常规液体管理，维持中心静脉压（central venous pressure，CVP）为6～12cmH2O；Ⅱ组在肝切除过程中联合应用肝血流阻断和CLCVP技术。CLCVP包括：限制液体输入和输注硝酸甘油，即从手术开始到肝实质分离完成时，液体输注速度控制在1～3mL／（kg·h）左右，并以输注晶体液为主，必要时输注硝酸甘油，维持CVP≤5cmH2O；在肝切除后，快速输入乳酸钠林格氏液和羟乙基淀粉130／0．4氯化钠注射液，恢复正常CVP。记录两组患者基本情况和手术信息，记录术前、气管插管后5min、肝切除开始、肝切除20min、肝切除后5min、手术结束时的平均动脉压（meanarterial pressure，MAP）、心率（hearl rate，HR）、CVP、脑电双频谱指数（bispectral index，BIS）等．结果：与Ⅰ组相比，Ⅱ组手术时间、出血量、输血量均明显减少（P〈0．05），两组尿量无显著性差异（P〉0．05）。两组患者术前各项指标比较无显著性差异（P〉0．05）。术中不同时点，两组患者MAP、HR也无显著性差异（P〉0．05）。与Ⅰ组相比，Ⅱ组CVP在肝切除开始及肝切除20min时显著下降（P〈0．05），BIS值在肝切除开始、肝切除20min及肝切除后5min显著降低（P〈0．05）。结论：肝血流阻断联合应用CLCVP技术能够有效降低肝切除术的术中出血量和减少输血。Objective： To investigate the effect of controlled low central venous pressure （CLCVP） combined with hepatic blood occlusion on blood loss and hemodynamics in hepatectomy. Methods： Sixty hepatocellular carcinoma patients with American Society of Anesthesiologists （ASA） Ⅰ - Ⅱ undergoing hepatectomy were randomly divided into two groups. One was the group of hepatic blood occlusion （group Ⅰ）; the other was the group of CLCVP combined with hepatic blood occlusion （group Ⅱ）. During the parenchymal transection phase of surgery, 6〈central venous pressure （CVP） 〈12 cm H2O were maintained in group Ⅰ, whereas 0〈CVP 45 cm H2O were maintained by limiting the fluid infusion and drugs in group Ⅱ. The operation time, blood loss, blood infusion, and urinary volume between the two groups were compared. The mean arterial pressure （MAP）, heart rate （HR）, CVP, and bispectral index （BIS） at different time points during surgery between the two groups were recorded and compared. Results： Compared with group Ⅰ, the operation time, blood loss, and blood infusion in group Ⅱ significantly decreased （P〈0.05）. No significant difference was found in urinary volume between the two groups （P〉0.05）. Likewise, no significant difference was noted in MAP and HR at different time points of the two groups （P〉0.05）. The CVP in group Ⅱ was significantly lower than that in group I at the beginning of and 20 min after the parenchymal transection phase of the surgery. Conclusion： CLCVP combined with hepatic blood occlusion can reduce blood loss effectivelyduring hepatectomy.

关 键 词：肝切除术 控制性低中心静脉压 肝血流阻断 麻醉 

分 类 号：R735.7[医药卫生—肿瘤] R614[医药卫生—临床医学]