低中心静脉压减少肝切除术中出血的临床研究

Value of low central venous pressure in reducing blood loss during hepatectomy

目的探讨低中心静脉压对减少肝癌(HCC)切除手术出血的影响.方法将2003年12月以前中山大学附属第一医院同一手术组医生施行肝切除术的HCC病人50例,按随机数字采用信封法分为低中心静脉压(LCVP)组和常规手术组(对照组),各为25例.LCVP组切肝时经体位、药物处理使CVP在2～4mmHg(1mmHg=0.133kPa)、收缩压>90mmHg,对照组则按常规处理,比较两组的术前一般情况、术中和切肝时的出血量及输血量、术后恢复情况和肝肾功能变化.结果两组病人术前一般情况差异无显著性.病人的肿瘤最大直径、手术方式、入肝血流阻断时间、手术时间、切除肝组织的重量、术后并发症发生、术后肝肾功能的恢复两组差异均无显著性.LCVP组手术出血量、切肝时出血量分别为(903.9±180.8)mL、(672.4±429.9)mL,均明显低于对照组(W值分别为495.5、543.5,P<0.01),而切肝前和切肝后的出血量两组差异无显著性意义.LCVP组术后留院时间为(16.3±6.8)d,对照组为(21.5±8.6)d,两组差异有显著性意义 (W=532.5,P<0.05).结论 LCVP技术在操作上简便易行,将中心静脉压控制在≤4mmHg,能够减少切肝过程的出血量、缩短术后留院时间、对病人肝肾功能无损害.

Objective To assess whether blood loss will be decreased during hepatectomy for hepatocellular carcinoma （HCC） by decreasing central venous pressure （CVP）. Methods Fifty patients with HCC admitted before December 2003 were randomly allocated to the low-CVP （LCVP） liver resection group （n=25） or routine hepatectomy control group （n=25）. During the parenchymal transection phase of surgery, the CVP of 2-4 mmHg and systolic blood pressure （SBP）〉90 mmHg were maintained in LCVP group by management of patient＇s body position and drugs use. However, no special management of CVP and SBP was done in the routine hepatectomy group. The total bleeding volume, parenchymal transection bleeding volume, blood transfusion,hospital stay ,postoperative hepatic and renal function changes between two groups were compared. Results No significant differences were observed in maximal tumor diameter, type of hepatectomy, time of vascular clamping, period of operation, weight of resected liver tissue, postoperative morbidity, postoperative hepatic and renal functions between the LCVP and the control group. Total bleeding volume and parenchymal transection bleeding volume in LCVP group were （903.9±180.8） mL and （672.4±429.9） mL respectively, which were significantly lower than those in control group （W=495.5 and 543.5, P〈0.01）. Hospital stay in LCVP group was significantly shortened compared with control group [ （16.3±6.8） d vs （21.5±8.6）d, W=532.5, P〈0.05）. Conclusions Lowering CVP during hepatectomy for HCC is easy to control. With the maintenance of CVP≤4mmHg, blood loss during parenchymal transection and hospital stay are markedly decreased, and it is no detrimental effect to hepatic or renal function.