腹腔镜肝切除术中控制性低中心静脉压技术实施要点与意外处理  

The clinical application of Controlled Low Central Venous Pressure(CLCVP)in laparoscopic hepatectomy:key points,possible complications and related management

作　　者：彭俊[1] 彭书崚[1] PENG Jun;PENG Shu-ling(Department of Anesthe-siology,Memorial Hospital,Sun Yat-sen University,Guang-zhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,广东广州510120

出　　处：《中国实用外科杂志》2022年第9期1039-1041,共3页Chinese Journal of Practical Surgery

摘　　要：控制性低中心静脉压(CLCVP)技术的合理实施,可减少腹腔镜肝切除术中出血、提供清晰手术视野、促进病损精准切除、实现病人术后加速康复,因此,近年来在临床上逐渐得到广泛应用。然而,这项技术有一定难度,若实施不当可能导致病人器官功能受损;因此,对麻醉医生的临床能力提出了较高要求。CLCVP技术的合理实施,首先应严格掌握其适应证、禁忌证;其次需在完善的“麻醉镇痛、镇静和抗应激”基础上进行限制性补液,同时辅以输注心血管活性药物、调节手术体位、优化通气等治疗措施;最后应确保过程中病人循环功能稳定、重要器官灌注正常。CLCVP技术实施过程中可能发生CO_(2)气栓、低氧血症、酸中毒和以急性肾功能损伤为代表的器官功能损害等意外事件,影响手术进行和病人预后。因此,围手术期应对可能的并发症进行积极预防、动态管理、及时处理。麻醉科医师在掌握上述实施要点和意外防治方法的前提下,通过不断实践、合理运用CLCVP技术,可为腹腔镜肝切除术提供良好手术条件,协助术者微创、精准切除肝脏病损,同时保障病人安全、促进快速康复。The Controlled Low Central Venous Pressure(CLCVP),which is considered to help with less bleeding,better surgical field,more precise tumor resection and faster recovery of the patients during laparoscopic hepatectomy,has been gradually applied in clinical work recently.However,this technique is difficult and can lead to organ damage if not performed properly.Therefore,the clinical ability of anesthesiologists is highly required.For the rational implementation of CLCVP technology,there are several key points to be followed,including but not limited to:indications to be complied with,strategies including restrictive fluid management along with vasoconstrictors and inotropes infusion on the basis of perfect"anesthesia analgesia,sedation and anti-stress",patient position adjustment and ventilation optimization to be performed,and finally,adequate perfusion to vital organs to be guaranteed.It is noteworthy that several medical incidents may occur during CLCVP implementation including carbon dioxide embolization,hypoxemia,acidosis and organ function damage represented by AKI,which may consequently influence the operation and patients’prognosis;hence,cautious prevention,close monitoring and treatment in time during perioperative period are critical in avoiding complications.Altogether,CLCVP can be safely performed by well trained and experienced anesthesiologists,thus to provide a better surgical condition for surgeons in laparoscopic hepatectomy,to assist the surgeon to minimally invasive and precise resection of liver lesions,and ensure patient safety and facilitate fast recovery of the patients.

关 键 词：控制性低中心静脉压 肝脏手术 腹腔镜 并发症 

分 类 号：R6[医药卫生—外科学]