药物控制与麻醉控制低中心静脉压在达芬奇机器人肝癌切除手术中的应用对比  

The Application of Low Central Venous Pressure by Drugs Control versus Anesthesia Control in Da Vinci Robot-assisted Hepatectomy of Hepatocellular Carcinoma

作　　者：李礼[1] 曾剑锋[1] 陆福鼎[1] 罗建伟[1] LI Li;ZENG Jian-feng;LU Fu-ding;LUO Jian-wei(Department of Anesthesiology,SunYat-sen Memorial Hospital of SunYat-sen University,Guangzhou,510289)

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,510289

出　　处：《岭南急诊医学杂志》2018年第5期453-456,共4页Lingnan Journal of Emergency Medicine

基　　金：广东省自然科学基金资助项目(2015A030313178)

摘　　要：目的:比较药物控制与麻醉控制低中心静脉压在达芬奇机器人肝癌切除手术中的应用。方法:前瞻性研究对象为2016年1月26日至2018年6月30日于中山大学孙逸仙纪念医院择期行达芬奇机器人肝癌切除手术患者,按照随机数字表法分为硝酸甘油+多巴酚丁胺组(ND组,n=25)和丙泊酚+瑞芬太尼组(PR组,n=25)。分别以硝酸甘油+多巴酚丁胺泵注和丙泊酚+瑞芬太尼泵注控制中心静脉压。比较两组术中一般情况,CVP调控情况,LCVP对循环、肝肾功能、脑功能的影响。结果:ND组和PR组两组患者手术时间、术中出血量、术中尿量、术毕-术前乳酸比较差异无统计学意义(P>0.05)。ND组和PR组两组患者LCVP时间、肝门阻断时间、降CVP时间、目标CVP数值比较无统计学意义(P>0.05);升CVP时间PR组明显快于ND组(P<0.01)。PR组LCVP期间低血压例数明显少于ND组(P<0.05);心率快例数明显少于ND组(P<0.01)。ND组和PR组两组患者ALT、AST、TBil、ALB、SCr、BUN在各时间点比较无统计学意义(P>0.05)。ND组和PR组两组患者苏醒Steward评6分时间比较无统计学意义(P>0.05)。结论:硝酸甘油复合多巴酚丁胺和丙泊酚复合瑞芬太尼控制LCVP均可用于达芬奇机器人肝癌切除手术,丙泊酚复合瑞芬太尼控制LCVP时更加平稳。Objective ： To investigate the application of Low Central Venous Pressure by drugs control versus anes-thesia control in Da Vinci robot-assisted hepatectomy of hepatoeellular carcinoma. Methods： 50 patients with HCC undergoing Da Vinci robot-assisted hepateetomy in SunYat-sen Memorial Hospital of SunYat-sen University from 26th Jan. 2016 to 30th Jun. 2018 were enrolled in this prospective study. The patients were assigned into NI3 group （n=25） and PR group （n=25） using a random number table. Low Central Venous Pressure was controlled by nitroglycerin combined with dobutamine in DN group, propofol combined with remifentanil in PR group. The intraoperative general condition, regulation of central venous pressure, effeetion on circulation system, liver and renal function, brain function by Low Central Venous Pressure of the two groups were compared. Results： There was no statistically significant difference in the operative time, blood loss, amount of urine, post-before operative change of lactic acid between the two groups （P〉 0.05 ）. No statistically significant difference in the time of Low Central Venous Pressure, obstructive time of portal vein, time of lower central venous pressure, target value of central venous pressure between the two groups （P〉0.05） , the time of upper central venous pressure were more quickly in group PR than group ND （P〈0.01）. Cases of hypotension were significantly lower in group PR than group ND （P〈0.05）. Cases of sinus tachycardia were significantly lower in group PR than group ND （P〈0.01）. There was no statistically significant difference in ALT, AST, TBil, ALB, SCr, BUN in the four points time between the two groups （P〉0.05）. No statistically significant difference in the time of 6 points of StewardScore （P〉0.05）. Conclusion：Low Central Venous Pressure controlled by nitroglycerin combined with dobutamine and propofol combined with remifentanil are both safe and effective in Da Vinci robot-assisted hepatectomy of hepatocellula

关 键 词：药物 麻醉 低中心静脉压 达芬奇机器人 肝癌 

分 类 号：R614[医药卫生—麻醉学] R735.7[医药卫生—外科学]