控制性低中心静脉压在肝叶切除手术中的应用

EFFECTIVENESS OF LOW CENTRAL VENOUS PRESSURE ON BLOOD LOSS DURING LIVER RESECTION

目的:观察低中心静脉压对肝叶切除手术术中出血量的影响。方法:择期全麻下行肝叶切除术患者74例,ASA～级。分为2组:低中心静脉压组(LCVP组)和对照组。LCVP组在肝实质完全离断过程中CVP控制在0～0.49kPa水平,对照组CVP维持在0.59～1.18kPa之间。观察两组病人术中总失血量、输血率和输血量,比较不同肝脏手术部位两组病人出血量和不同第一肝门血流处理法中两组病人术中出血量。结果:LCVP组和对照组术中出血量分别为(427±317)ml和(800±709)ml,P<0.05。LCVP组在不同部位肝叶切除术术中出血量均少于对照组,尤其在、肝段手术时明显(P<0.05)。LCVP组和对照组术中不进行第一肝门血流阻断者术中出血量分别为(475±402)ml和(584±445)ml,两者无明显差异。进行肝门阻断者,LCVP组出血量明显少于C组,分别为(413±297)ml和(774±522)ml(P<0.05)。术中LCVP组和对照组分别有5例(5/37)和16例(16/37)需输注全血或浓缩红细胞,输血率比较差异有统计学意义(P<0.01)。需输血病人中,对照组平均输血(843±411)ml,而LCVP组仅为(400±244)ml(P<0.05)。结论:低中心静脉压可减少肝叶切除手术术中出血量。

Objective：To investigate the effectiveness of low central venous pressure on blood loss during liver resection. Methods： 74 patients, ASA Ⅰ-Ⅱ, undergoing selective liver resection under general anesthesia, were randomly assigned to two groups： low central venous pressure group （LCVP group, n = 37） and control group （C group, n =37）. Central venous pressure （CVP） was maintained at 0to 0.49 kPa during liver parenchyma dissection in LCVP group, and it was maintained at 0.59 to 1.18 kPa in C group. Total blood loss and blood transfusion during operation were collected in the two groups. The volume of blood loss was compared in different segments of liver resection in the two groups. The volume of blood loss during liver resection with and without portal triad occlusion was compared in the two groups. Result： The blood loss during operation was significantly less in the LCVP group than that in the C group （427±317）ml vs （800±709）ml （P 〈0.05）. The volumes of blood loss in different segments of liver resection in the LCVP group were less than those in the C group respectively, and blood loss was significantly less in liver resection of the Ⅶand Ⅷ segments in the LCVP group than that in the C group （569±361） ml vs （1 050±589）ml （P 〈0. 05）. The mean blood loss without portal trial occlusion in the LCVP group was （475±402）ml（n =8） and in the C group it was （584±445）ml （n =13） （P〉0.05）. The mean blood loss with portal trial occlusion in the LCVP group was significantly less than that in the C group, and there were （413±297）ml （n=29） and （774±522）ml （n =24） respectively （P〈0.05）. 5 patients in the LCVP group had a blood transfusion mean （400±244）ml and 16 patients in the C group mean （843±411） ml, and there was significant different between the two groups （ P 〈0. 05）. Conclusion： Low central venous pressure reduced the blood loss during liver resection.