醋酸去氨加压素联合控制性低中心静脉压技术对肝叶切除术患者凝血功能和出血量的影响  

Effect of Desmopressin Acetate Combined with Controlled Low Central Venous Pressure on Coagulation Function and Amount of Blood Loss in Patients with Hepatic Lobectomy

作　　者：李圣平[1] 何恺 汪威廉 霍成龙 王帅[1] LI Shengping;HE Kai;WANG Weilian;HUO Chenglong;WANG Shuai(Jingzhou Central Hospital,Hubei Province,Jingzhou 434020,China)

机构地区：[1]湖北省荆州市中心医院,湖北荆州434020

出　　处：《中国医学创新》2023年第9期27-31,共5页Medical Innovation of China

基　　金：荆州市2022年医疗卫生科技计划项目(2022HC25)。

摘　　要：目的:临床观察醋酸去氨加压素(DDAVP)联合控制性低中心静脉压(LCVP)技术对腹腔镜下行肝叶切除术患者凝血功能和出血量影响。方法:选取2022年1-6月荆州市中心医院荆北院区肝胆外科收治的肝血管瘤、肝癌和肝胆管结石等100例拟在腹腔镜下行肝叶切除术的患者,随机分为试验组和对照组,每组50例。试验组给予醋酸DDAVP联合LCVP,于术前1 d、术中及术后1 d静脉滴注醋酸DDAVP 15μg(用0.9%氯化钠溶液稀释至50 mL),术中采用控制性低中心静脉压技术,维持中心静脉压(CVP)<5 cmH2O。对照组给予正常中心静脉压管理,维持CVP在5~9 cmH2O,于术前1 d、术中及术后1 d静脉滴注0.9%氯化钠溶液50 mL。记录两组麻醉诱导前(T_(1))、肝叶切除操作时(T_(2))、肝叶切除完成时(T_(3))、术毕(T_(4))时、术后1 h(T_(5))、术后1 d(T_(6))及术后3 d(T_(7))的心率(HR)与平均动脉压(MAP)水平,同时记录术中出血量、术后引流量及并发症。采集两组T_(1)、T_(5)、T_(6)、T_(7)静脉血测定凝血功能(PT、ACT、APTT)。结果:T_(1)、T_(5)、T_(6)、T_(7)时,两组HR、MAP比较,差异均无统计学意义(P>0.05);两组T_(2)~4时HR、MAP比较差异均有统计学意义(P<0.05)。两组T_(1)、T_(5)、T_(6)、T_(7)时的PT、ACT、APTT比较,差异均无统计学意义(P>0.05)。试验组总输液量、术中出血量、手术时间和术后引流量均低于对照组(P<0.05)。结论:DDAVP联合LCVP技术在腹腔镜下行肝叶切除手术中出血量明显减少,可提高安全性,且不对凝血功能形成影响。Objective:To observe the effect of desmopressin acetate(DDAVP)combined with controlled low central venous pressure(LCVP)on coagulation function and bleeding in patients with hepatic lobectomy under laparoscope.Method:A total of 100 patients with hepatic hemangioma,liver cancer and hepatolithiasis who were to undergo laparoscopic hepatobiliary resection in the Department of Hepatobiliary Surgery,Jingbei Courtyard District,Jingzhou Central Hospital from January to June 2022 were selected and randomly divided into experimental group and control group,with 50 cases in each group.The experimental group was given acetate DDAVP combined with LCVP,and 15μg of acetate DDAVP(diluted to 50 mL with 0.9%sodium chloride solution)was injected intravenously 1 day before surgery,during surgery and 1 day after surgery.The central venous pressure(CVP)was maintained<5 cmH 2O by controlled hypovenous pressure technique during surgery.The control group was given normal central venous pressure management,CVP was maintained in the range of 5-9 cmH2O,and 50 mL 0.9%sodium chloride solution was injected intravenously 1 day before,during and 1 day after surgery.The heart rate(HR)and mean arterial pressure(MAP)levels of the two groups were recorded before anesthesia induction(T_(1)),at the time of hepatectomy(T_(2)),at the completion of hepatectomy(T_(3)),after surgery(T_(4)),1 h after surgery(T_(5)),1 d after surgery(T 6)and 3 d after surgery(T_(7)).The intraoperative blood loss,postoperative drainage and complications were also recorded.T_(1),T_(5),T_(6) and T_(7) venous blood of the two groups were collected to determine coagulation function(PT,ACT and APTT).Result:At T_(1),T_(5),T_(6) and T_(7),there were no significant differences in HR and MAP between the two groups(P>0.05).There were significant differences in HR and MAP between the two groups at T_(2)-4(P<0.05).There were no significant differences in PT,ACT and APTT at T_(1),T_(5),T_(6) and T_(7) between the two groups(P>0.05).The total infusion volume,intraoperative blood loss,ope

关 键 词：醋酸去氨加压素 控制性低中心静脉压技术 肝叶切除术 凝血功能 出血量 

分 类 号：R657.3[医药卫生—外科学]