控制性低中心静脉压联合第一肝门间歇性阻断对巨大肝癌切除术围术期肝肾功能的影响  

Effect of controlled low central venous pressure combined with intermittent first hepatic portal occlusion on perioperative liver and kidney functions of huge liver cancer resection

作　　者：孙浩 曹丽 周斌 SUN Hao;CAO Li;ZHOU Bin(Department of Anesthesia,Qinhuai Medical District,Eastern Theater General Hospital,Nanjing,Jiangsu 210002,China)

机构地区：[1]东部战区总医院秦淮医疗区麻醉科,江苏南京210002

出　　处：《淮海医药》2021年第6期567-570,575,共5页Journal of Huaihai Medicine

摘　　要：目的:研究控制性低中心静脉压联合第一肝门间歇性阻断在巨大肝癌切除术中对围术期患者肝肾功能的影响。方法:选择某院行巨大肝癌切除术患者79例,按照中心静脉压高低分为控制性低中心静脉压联合第一肝门间歇性阻断组(L组)40例和正常中心静脉压联合第一肝门间歇性阻断组(N组)39例,观察2组患者术中出血量、术中输血量、术中总输液量、手术时间、术后肝肾功能指标变化情况及出院时间。结果:L组患者术中出血量、术中输血率、术中输液量少于N组,手术时间短于N组,差异均有统计学意义(P<0.05);2组患者术后出院时间比较,差异无统计学意义(P>0.05);2组患者手术前后天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及总胆红素(TBIL)指标各时间节点组间比较,差异无统计学意义(P>0.05);2组患者术后肝功能指标均较术前增高,术后第1天到达峰值,术后第7天基本恢复正常,组内比较差异有统计学意义(P<0.05);2组患者术后肾功能指标较术前无明显改变,差异无统计学意义(P>0.05)。结论:控制性低中心静脉联合第一肝门间歇性阻断在巨大肝癌切除术中应用,能够减少术中出血量,降低术中输血率和术中输液总量,对术后AST、ALT有短暂影响,术后1周基本恢复正常,不延长患者的出院时间。Objective:To study the effect of controlled low central venous pressure combined with intermittent first hepatic portal occlusion on perioperative liver and kidney functions of patients undergoing huge liver cancer resection.Methods:79 patients undergoing huge liver cancer resection in our hospital from January 2015 to December 2019 were included and analyzed.According to different central venous pressures,they were divided into group L(low central venous pressure combined with intermittent first hepatic portal occlusion,40 cases),and group N(normal central venous pressure combined with intermittent first hepatic portal occlusion,39 cases).Length of operation time,changes of liver and kidney function indexes and discharge time of the two groups after operation were compared and analyzed.Results:Blood loss,intraoperative blood transfusion ratio,total intraoperative infusion volume and operation time in group L were significantly less or lower than those in group N(P<0.05).There was no significant difference in postoperative discharge time(P>0.05).Liver function indexes in both groups were higher than those before operation,reaching the peak on the first day after operation and returning to normal 7 days after operation(P<0.05).There was no significant difference in AST and ALT between the two groups on the perioperative days(P>0.05).There was no significant difference in both groups in renal function index changes before and after operation(P>0.05).Conclusion:The application of controlled low central venous pressure combined with intermittent first hepatic portal occlusion in giant hepatectomy can reduce intraoperative blood loss,decrease intraoperative blood transfusion rate and total amount of intraoperative infusion,which may impose temporary impact on postoperative AST and ALT,and will basically return to normal one week after operation,without prolonging the discharge time of patients.

关 键 词：巨大肝癌 控制性低中心静脉压 第一肝门间歇性阻断 

分 类 号：R735.7[医药卫生—肿瘤]