低中心静脉压对肝叶切除病人术中出血及肾功能的影响

The effect of low central venous pressure on blood loss and renal function during liver resection

目的观察低中心静脉压(LCVP)对肝叶切除手术出血量和肾功能的影响。方法LCVP组在肝实质完全离断过程中中心静脉压(CVP)控制在0～5cmH2O(1cmH2O=0.098kPa),C组CVP维持在6～12cmH2O之间。观察两组病人术中总失血量、输血率和输血量,比较肝脏手术部位不同及第一肝门血流处理法不同的两组病人术中出血量,术前、术毕肾功能变化。结果LCVP组和C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C组。进行第一肝门阻断者,LCVP组出血量明显少于C组。术中LCVP组输血量明显少于C组。两组病人术前、术中肾功能无明显变化。结论低中心静脉压可减少肝叶切除术中的出血量,对手术中病人肾功能无明显影响。

Objective To investigate the effect of low central venous pressure on blood loss and renal function during liver resection. Methods Seventy-four patients（ ASA Ⅰ-Ⅱ）, undergoing selective liver resection under general anesthesia in our hospital from August 2003 to November 2004 ,were randomly divided into 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 0 to 5 cmH20 （ 1cmH2O =0. 098kPa） during liver parenchyma dissection in LCVP group,and it was maintained at 6 to 12 cmH2O in C group. Total blood loss and blood transfusion during operation were collected in two groups. The volume of blood loss was compared in different segments of liver resection in two groups. The volume of blood loss during liver resection with and without portal trial occlusion was compared in two groups. The renal function before and after operation was compared in two groups. Results The blood loss during operation was significantly less in the LCVP group than that in the C group [ （427 ± 317） mL v. s （800 ± 709）mL, P 〈 0.051. The volumes of blood loss in different segments of liver resection in the LCVP group were tess than those in the corresponding C group. The mean blood loss with portal trial occlusion in the LCVP group was significantly less than that in the C group [ （413±297）mL, n =29 v. s （774±522） mL, n = 24, P 〈 0. 05 ]. The renal function before and after operation was no significant difference between the two groups. Condusion Low central venous pressure can reduce the blood loss during liver resection and has not influence on renal function.