控制性低中心静脉压在复杂性腹腔镜肝切除术中的应用研究  

Application of controlled low central vein pressure in complex laparoscopic hepatectomy

作　　者：何龙光[1] 陈钦寿[1] 李大生[1] 黎福良[1] 黄军伟[1] HE Longguang;CHEN Qinshou;LI Dasheng;LI Fuliang;HUANG Junwei(Department of Hepatobiliary Surgery,Gaozhou People’sHospital,Gaozhou 525200,Guangdong,China)

机构地区：[1]高州市人民医院肝胆外科,广东高州525200

出　　处：《外科研究与新技术》2021年第1期14-16,26,共4页Surgical Research and New Technique

摘　　要：目的探讨控制性低中心静脉压(CVP)在复杂性腹腔镜肝切除术中的应用效果。方法将2018年1月—2020年5月收治的60例行复杂性腹腔镜肝切除术患者随机分为观察组和对照组,每组各30例。观察组采用控制性低CVP技术,CVP保持在1~3 cmH2O,动脉收缩压≥90 mmHg;对照组应用常规手术操作,CVP保持在6~12 cmH_(2)O。比较两组术中出血量、手术时间、血气分析、肝肾功能、胆漏并发症发生情况。结果观察组各手术指标均优于对照组(P<0.05);术后1 d,两组血尿素氮、血肌酐、血丙氨酸转氨酶、总胆红素指标均增高,观察组指标提升幅度较小(P<0.05);术后1 d,两组pH值、血氧饱和度指标无差异(P>0.05),但观察组血氧饱和度、碱剩余值更低,HCO-3值更高(P<0.05);观察组胆漏发生率较低(P<0.05)。结论施行复杂性腹腔镜肝切除术时采用控制性低CVP技术可减少术中出血量及输血量,减少并发症发生率,优化手术效果,安全性较高,住院时间较短,对肝肾功能无明显影响。Objective To investigate the effect of controlled low central vein pressure on complex laparoscopic hepatectomy.Methods From January 2018 to May 2020,60 patients with complex laparoscopic hepatectomy were randomly divided into an observation group(n=30)and a control group(n=30).The observation group was treated by controlled low central venous pressure technique to maintain central venous pressure(CVP)at 1-3 cmH2O and SAP≥90;while the control group was given conventional operation to keep CVP at 6-12 cmH2O.The intraoperative blood loss,operation time,blood gas indicators,liver and kidney functions,and bile leakage complications were compared between the two groups.Results The operation indexes in the observation group were better than those in the control group(P<0.05).On postoperative day 1,the blood urea nitrogen,serum creatinine,alanine aminotransferase,and total bilirubin in both groups were increased,while the indexes in the observation group were slightly elevated(P<0.05);there was no difference in pH and SpO2 between the two groups(P>0.05),while the PaO2 and BE in the observation group were lower,and the HCO-3 was higher than those in the control group(P<0.05).The incidence of bile leakage was lower in the observation group(P<0.05).Conclusion In patients undergoing complex laparoscopic hepatectomy,the use of controlled low central venous pressure technique can reduce the amount of bleeding and blood transfusion and reduce the incidence of complications,thereby optimize operation effect,greatly improve the safety of liver surgery,and shorten the length of hospital stay,while not produce significant adverse effects on liver and kidney functions.

关 键 词：控制性低中心静脉压 腹腔镜肝切除术 术中出血量 手术时间 肝肾功能 胆漏 

分 类 号：R657.4[医药卫生—外科学]