不同水平控制性低中心静脉压技术用于腹腔镜肝切除术患者安全性及有效性研究  

Safety and effectiveness of different levels of controlled low central venous pressure in patients undergoing laparoscopic liver resection

作　　者：李莘 马丽[2] 刘杰[1] 苏明星 孟宇航 王立金 陈小兰 孙立[3] 赵艳娟 LI Xin;MA Li;LIU Jie;SU Ming-xing;MENG Yu-hang;WANG Li-jin;CHEN Xiao-lan;SUN Li;ZHAO YAN-juan(North Beijing Medical District,Chinese PLA General Hospital,Beijing 100096,China;Department of Anesthesia,The Seventh Medical Center of Chinese PLA General Hospital,Beijing 100010,China;Department of Anesthesia and Extracorporeal Circulation,Department of Cardiovascular Medicine,The Sixth Medical Center of Chinese PLA General Hospital,Beijing 100037,China;General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]解放军总医院京北医疗区,北京100096 [2]解放军总医院第七医学中心麻醉科,北京100010 [3]解放军总医院第六医学中心,心血管病医学部麻醉与体外循环科,北京100037 [4]北部战区总医院,辽宁沈阳110016

出　　处：《临床军医杂志》2024年第4期369-373,共5页Clinical Journal of Medical Officers

基　　金：全军医学科技青年培育计划孵化项目(19QNP059)。

摘　　要：目的探讨不同水平控制性低中心静脉压(CLCVP)对腹腔镜肝切除术(LH)患者的安全性及有效性,为CLCVP在肝胆外科领域的合理应用提供参考。方法选取自2020年1月至2022年12月就诊于解放军总医院第七医学中心并行LH的137例患者为研究对象。根据术中是否采用CLCVP技术及CLCVP的水平将患者分为3组:A组(n=43)实施全入肝Pringle法,不采用CLCVP技术;B组(n=48)实施Pringle法联合CLCVP技术,中心静脉压(CVP)为1~2 cmH_(2)O;C组(n=46)实施Pringle法联合CLCVP技术,CVP为3~5 cmH_(2)O。比较3组患者的切肝时间、出血量、尿量、总输液量;术前及术后1、3 d的血气分析指标[动脉血氧饱和度(SaO_(2))、碳酸氢根(HCO_(3)^(-))、碱剩余(BE)]及肝肾功指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮(BUN)、肌酐(Cr)]。结果B组、C组患者的切肝时间、出血量、尿量和总输液量明显少于A组,差异均有统计学意义(P<0.05)。术前及术后1、3 d,3组患者的SaO_(2)比较,差异均无统计学意义(P>0.05);术前,3组患者的HCO_(3)^(-)和BE水平比较,差异均无统计学意义(P>0.05);术后1、3 d,C组患者的HCO_(3)^(-)和BE水平高于A组、B组,差异有统计学意义(P<0.05)。术前,3组患者的AST、ALT、BUN和Cr水平比较,差异均无统计学意义(P>0.05);术后1、3 d,3组的BUN和Cr水平比较,差异均无统计学意义(P>0.05);术后1、3 d,C组的ALT和AST水平均低于A组、B组,差异有统计学意义(P<0.05)。结论CLCVP技术可以减少LH术中出血量并缩短手术时间,且不影响患者血氧饱和度和肾功能,具有较好的安全性;当CLCVP控制在3~5 cmH_(2)O时,对患者肝功能及酸碱平衡影响较小,术后恢复较快,且可以更好地维持体内酸碱代谢平衡。Objective To explore the safety and efficacy of different levels of controlled low central venous pressure(CLCVP)in patients undergoing laparoscopic hepatectomy(LH),and to provide reference for the reasonable application of CLCVP in hepatobiliary surgery.Methods A total of 137 patients with concurrent LH were selected from the Seventh Medical Center of Chinese PLA General Hospital from January 2020 to December 2022.Patients were divided into 3 groups according to whether CLCVP technique was used and the level of CLCVP.Group A(n=43)received Pringle method without CLCVP technique.Group B(n=48)underwent Pringle method combined with CLCVP technology,and the central venous pressure(CVP)was 1-2 cmH_(2)O.Group C(n=46)underwent Pringle method combined with CLCVP technology,and the CVP was 3-5 cmH_(2)O.The time of liver resection,blood loss,urine volume and total infusion volume of the 3 groups were compared.Blood gas analysis indexes[arterial oxygen saturation(SaO_(2)),bicarbonate(HCO_(3)^(-)),alkali residual(BE)]and liver and kidney function indexes[alanine transaminase(ALT),aspartate aminotransferase(AST),blood urea nitrogen(BUN),creatinine(Cr)]before and 1 and 3 days after surgery of the 3 groups were compared.Results The liver resection time,blood loss,urine volume and total infusion volume in group B and group C were significantly lower than those in group A,and the differences were statistically significant(P<0.05).There was no significant difference in SaO_(2)among 3 groups before surgery and 1 and 3 days after surgery(P>0.05).Before surgery,there was no significant difference in HCO_(3)^(-)and BE levels among 3 groups(P>0.05).The levels of HCO_(3)^(-)and BE in group C were significantly higher than those in group A and group B on the 1st and 3rd day after surgery,with statistical significance(P<0.05).Before surgery,there were no significant differences in AST,ALT,BUN and Cr levels among 3 groups(P>0.05).On the 1st and 3rd day after operation,there were no significant differences in BUN and Cr levels among the 3 g

关 键 词：控制性低中心静脉压 腹腔镜肝切除术 临床疗效 安全性 

分 类 号：R657.3[医药卫生—外科学]