可控性低中心静脉压技术在肝切除术中应用的最适中心静脉压  

Optimal central venous pressure of controllable low central venous pressure technique in hepatectomy

作　　者：杭轶 杨小勇 李文美 薛磊 Hang Yi;Yang Xiaoyong;Li Wenmei;Xue Lei(Department of Emergency Surgery,Xuzhou Central Hospital,Jiangsu Province,Xuzhou 221000,China;Department of Hepatobiliary Surgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]江苏省徐州市中心医院急诊外科,221000 [2]徐州医科大学附属医院肝胆外科,江苏省徐州市221000

出　　处：《中华肝脏外科手术学电子杂志》2024年第6期813-817,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨控制性低中心静脉压技术(CLCVP)在肝切除术中应用的最适中心静脉压。方法本研究对象为2020年1月至2023年1月在徐州医科大学附属医院由同一组医师完成的58例肝切除术患者。患者均签署知情同意书,符合医学伦理学规定。患者均采用入肝血流阻断联合CLCVP,术前随机给患者制定CLCVP目标范围,按设定的CVP目标将患者分为3组:4~5 cmH_(2)O(1 cmH_(2)O=0.098 kPa)为A组(23例),2~3 cmH_(2)O为B组(20例),0~1 cmH_(2)O为C组(15例)。术中先以外科方法降低CVP,如未达目标则继续以麻醉方法处理以使患者CVP达到预设目标,记录3组患者的围手术期资料。3组出血量比较采用单因素方差分析,率的比较采用χ^(2)检验。结果A组22%(5/23)的患者需外科方法联合麻醉方法控制CVP,明显少于B组的75%(15/20)及C组的93%(14/15)(χ^(2)=12.190,18.610;P<0.05)。C组有87%(13/15)的患者需补液扩容等处理以维持血压稳定,明显多于A组的22%(5/23)及B组的30%(6/20)(χ^(2)=12.850,8.930;P<0.05)。A组切肝时平均出血量为(711±280)ml,明显多于B组的(491±242)ml及C组的(468±241)ml(LSD-t=2.729,2.755;P<0.05)。结论CLCVP在肝切除术中应用的最适CVP控制为2~3 cmH_(2)O,切肝时出血量明显减少,且对血压影响小,技术操作难度不大。Objective To investigate the optimal central venous pressure of controlled low central venous pressure(CLCVP)in hepatectomy.Methods 58 patients undergoing hepatectomy in the Affiliated Hospital of Xuzhou Medical University by the same group of surgeons from January 2020 to January 2023 were enrolled in this study.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were treated with hepatic inflow occlusion combined with CLCVP.The target range of CLCVP was randomly set before surgery.According to the predetermined CVP target,23 patients were divided into group A(4-5 cmH_(2)O,1 cmH_(2)O=0.098 kPa),20 cases in group B(2-3 cmH_(2)O),and 15 cases in group C(0-1 cmH_(2)O).Intraoperatively,the CVP was reduced by surgical interventions.If the target CVP was not reached,anesthesia was given to make the CVP reach the predetermined target.Perioperative data were recorded in three groups.The blood loss among three groups was compared by one-way ANOVA,and the rate was compared by Chi-square test.Results In group A,22%(5/23)of the patients required surgery combined with anesthesia to control CVP,significantly less than 75%(15/20)in group B and 93%(14/15)in group C(χ^(2)=12.190,18.610;P<0.05).In group C,87%(13/15)patients needed fluid replacement and volume expansion to maintain blood pressure stability,significantly higher than 22%(5/23)in group A and 30%(6/20)in group B(χ^(2)=12.850,8.930;P<0.05).The average blood loss in group A was(711±280)ml,significantly higher than(491±242)ml in group B and(468±241)ml in group C(LSD-t=2.729,2.755;P<0.05).Conclusions The optimal CVP of CLCVP should be maintained at 2-3 cmH_(2)O in hepatectomy,which significantly reduces the amount of bleeding during hepatectomy,exerts slight effect on blood pressure and decreases surgical difficulty.

关 键 词：中心静脉压 肝切除术 肝门阻断 术中出血量 

分 类 号：R657.3[医药卫生—外科学]