肝脏手术中脉压变异率和中心静脉压相关性研究  

Correlation of pulse pressure variation with central venous pressure in hepatic surgery

作　　者：梁超琴 张光英[2] 林成新[2] Liang Chaoqin;Zhang Guangying;Lin Chengxin(Department of Anesthsiology,Wuming Hospital Affiliated to Guangxi Medical University,Wuming 530199,China;Department of Anesthsiology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属武鸣医院麻醉科,武鸣530199 [2]广西医科大学第一附属医院麻醉科,南宁530021

出　　处：《广西医科大学学报》2021年第1期156-160,共5页Journal of Guangxi Medical University

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题资助项目(No.Z20190872)。

摘　　要：目的:观察肝脏手术中进行控制性降低中心静脉压(CLCVP)时中心静脉压(CVP)和脉压变异率(PPV)的变化,探讨PPV能否作为肝脏手术中容量管理的有效监测指标。方法:选择2018年9月至2019年2月广西医科大学第一附属医院肝胆外科收治的择期全身麻醉下行肝肿瘤或肝部分切除术的患者31例,入室后局麻下行中心静脉置管和桡动脉插管,连接监护仪监测CVP和PPV。常规快诱导气管插管机械通气,记录麻醉诱导后采自体血前(T0)、采集自体血液后(T1)、肿瘤切除前低CVP时(CVP<0.490 kPa,T2)、肿瘤切除CVP恢复后(CVP>0.490 kPa,T3),4个不同时间点的CVP和PPV,对不同时间点的CVP及对应的PPV进行相关性分析。结果:CVP和PPV之间存在线性关系。在自体血采血前、后CVP和PPV呈负相关关系(r=-0.434,P<0.001);肿瘤切除前、后CVP和PPV呈负相关关系(r=-0.7,P<0.001),CVP越低,PPV值越高,CVP<0.490 kPa时PPV大于12%;容量变化前、后PPV与CVP各时间点两两比较,差异具有统计学意义(P<0.05)。结论:肝脏手术时CVP和PPV两者之间存在相关性,有可能通过控制PPV进行容量管理,以减少肝脏手术出血量。Objective:To observe the changes of central venous pressure(CVP)and rate of pulse pressure variation(PPV)during controlled low central venous pressure(CLCVP)in liver surgery.Explore whether PPVcan be used as an effective monitoring index for volume management in liver surgery.Methods:From September 2018 to February 2019,31 patients with elective hepatic tumor resection under general anesthesia in our hospital were selected.All patients were treated with internal jugular vein catheterization and radial artery catheterization preoperatively.CVP and PPV were recorded at different time points:before autologous blood collection(T0),after autologous blood collection(T1),before tumor resection and CVP<0.490 kPa(T2),after tumor resection and CVP>0.490 kPa(T3).The correlation of CVP and corresponding PPV at different time points was analyzed.Results:There was a linear relationship between CVP and PPV.There was a negative correlation between CVP and PPV before and after autologous blood collection(r=0.434,P<0.001).There was a negative correlation between CVP and PPV before and after tumor resection(r=0.7,P<0.001).The lower the CVP,the higher the PPV,and the PPV was more than 12%when the CVP was less than 0.490 kPa.The pairwise comparison of PPV and CVP before and after volume change was statistically significant(P<0.05).Conclusion:There is a correlation between CVP and PPV during liver surgery,and it is possible to control PPV for volume management to reduce the amount of blood loss during liver surgery.

关 键 词：肝脏手术 全身麻醉 中心静脉压 脉压变异率 容量管理 

分 类 号：R614.2[医药卫生—麻醉学]