脉压变异度联合控制性低中心静脉压监测在高海拔地区肝包虫病患者手术中的应用  

Application of pulse pressure variability combined with controlled low central venous pressure monitoring in surgery for hepatic hydatid disease patients in high-altitude areas

作　　者：张培福[1] 王学军[1] 高世龙 熊成龙 Zhang Peifu;Wang Xuejun;Gao Shilong;Xiong Chenglong(Department of Anesthesiology,Qinghai Red Cross Hospital,Xining 810000,China)

机构地区：[1]青海红十字医院麻醉科,西宁810000

出　　处：《国际麻醉学与复苏杂志》2025年第3期255-258,共4页International Journal of Anesthesiology and Resuscitation

基　　金：青海省卫生健康委员会指导性计划课题(2023-wjzdx-86)。

摘　　要：目的探讨高海拔地区脉压变异度(PPV)联合控制性低中心静脉压(CVP)监测在肝包虫切除术中的应用。方法选取择期行肝包虫切除术的患者50例,按随机数字表法分为PPV联合CVP监测组(观察组,25例)和常规麻醉组(对照组,25例)。观察组进行PPV联合控制性低CVP监测下指导容量治疗;对照组行常规补液,维持CVP在正常范围内。记录并比较两组患者一般资料(性别、年龄、体重指数、美国麻醉医师协会分级),术中出血量,肝门阻断时间,切除肝包虫时间,术前、术毕动脉血气指标[乳酸值(Lac)、血红蛋白(Hb)、血细胞比容(Hct)]水平及术前和术后1 d肝肾功能指标[总胆红素(TBil)、血尿素氮(BUN)、血肌酐(Scr)]水平。结果两组患者一般资料差异无统计学意义(均P>0.05)。与对照组比较,观察组患者术中出血量较少,肝门阻断时间、切除肝包虫时间较短(均P<0.05)。两组患者术前Lac、Hb、Hct水平差异无统计学意义(均P>0.05);与对照组比较,观察组患者术毕Lac水平较低(P<0.05),Hb、Hct水平较高(均P<0.05)。与术前比较,术毕两组患者Lac水平升高(均P<0.05),Hb、Hct水平下降(均P<0.05)。术前及术后1 d两组患者肝肾功能指标水平差异无统计学意义(均P>0.05)。结论PPV联合控制性低CVP监测能显著减少肝包虫切除术术中出血量,减少肝门阻断时间,缩短切除肝包虫时间,且对术后肝肾功能无明显影响。Objective To investigate the application of pulse pressure variability(PPV)combined with controlled low central venous pressure(CVP)monitoring during resection of liver hydatid cysts in high-altitude areas.Methods A total of 50 patients who were scheduled for resection of liver hydatid cysts were selected.According to the random number table method,the patients were divided into two groups(n=25):pulse pressure variability combined with central venous pressure monitoring(an observation group),and conventional anesthesia(a control group).The observation group underwent fluid therapy guided by PPV combined with controlled low CVP monitoring,while the control group received conventional fluid supplementation to maintain CAP within the normal range.Both groups were compared for their general information[sex,age,body mass index,and American Society of Anesthesiologists(ASA)classification],intraoperative blood loss,hepatic portal occlusion time,hydatid cyst resection time,pre-operative and post-operative arterial blood gas indicators[lactate(Lac),hemoglobin(Hb),and hematocrit(Hct)],as well as pre-operative and postoperative day 1 hepatic and renal function indicators[total bilirubin(TBil),blood urea nitrogen(BUN),and serum creatinine(Scr)].Results There were no statistical differences in general information between the two groups(all P>0.05).Compared with the control group,the observation group showed significant decreases in intraoperative blood loss,hepatic portal occlusion time,and hydatid cyst resection time(all P<0.05).There were no statistical differences in Lac,Hb,and Hct levels between the two groups before surgery(all P>0.05);compared with the control group,the observation group showed decreases in Lac levels and increases in Hb and Hct levels after surgery(all P<0.05).Compared with preoperative levels,both groups presented increases in postoperative Lac levels,and decreases in Hb and Hct levels(all P<0.05).There were no statistical differences in hepatic and renal function indicators between the two groups bef

关 键 词：脉压变异度 低中心静脉压 高海拔地区 肝包虫病 

分 类 号：R657.3[医药卫生—外科学]