控制性低中心静脉压技术在精准肝切除术中的应用

Application of controlled low central venous pressure in precision liver resection

  • 摘要: 目的 评价控制性低中心静脉压技术对精准肝切除患者术中出血量和肾功能的影响。 方法 50例择期行精准肝切除患者随机分为低中心静脉压(low central venous pressure,LCVP)组25例和对照组25例,均采用静吸复合麻醉方法,术中连续监测中心静脉压和有创动脉压。LCVP组从麻醉诱导后到肝病灶切除并止血完成后通过限制液体输入、调节头高脚底体位(头高10°-15°)及吸入异氟醚和(或)持续微量泵注硝酸甘油0.1-2μg/(kg.min)将中心静脉压控制在<4mmHg(1mmHg=0.133kPa),对照组术中采取正常麻醉管理方法,中心静脉压维持在正常范围。记录术中出血量和输血量,术前和术后24h抽静脉血查肌酐(Cr)和尿素氮(BUN)值。 结果 LCVP组和对照组术中失血量分别为(342.3±208.2)ml和(648.4±381.2)ml(P<0.05);两组手术前后肾功能变化差异无统计学意义(P>0.05)。 结论 控制性低中心静脉压麻醉技术应用在精准肝切除手术中可明显降低术中出血量且对患者肾功能无明显影响。

     

    Abstract: Objective To assess the effect of controlled low central venous pressure(CLCVP) on blood loss and renal function during precision liver resection. Methods Fifty patients were randomly divided into LCVP group(n=25)and control group(n=25).The patients underwent LCVP under venous and inhalation anesthesia,during which their central venous pressure(CVP) and invasive blood pressure were continuously monitored.The CVP of patients in LCVP group was controlled below 4mmHg from the beginning of anesthesia to the resection of lesions and hemostasis by limiting the fluid infusion,raising the head to 10°-15°,inhaling isoflurane and/or continuously pumping nitroglycerin at 0.1-2μg/kg.min.The CVP of patients in control group was maintained at the normal range.Blood loss and blood transfusion were measured during operation.Creatinine(Cr) and blood urea nitrogen(BUN) in venous blood sample were detected before and 24h after operation. Results The blood loss was lower in LCVP group than in control group((342.3±208.2)ml vs(648.4±381.2)ml,P<0.05).No significant difference was found in renal function between the two groups before and after operation(P>0.05). Conclusion Application of LCVP in precision liver resection can significantly reduce blood loss during operation with no remarkable effect on renal function.

     

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