控制性低中心静脉压对肝叶切除术患者α_1-微球蛋白的影响

Effects of controlled low central venous pressure on α_1-microglobulin of patients undergoing hepatic lobectomy

目的观察在控制性低中心静脉压(LCVP)下行肝叶切除术患者血、尿α1-微球蛋白(α1-MG)的变化,探讨控制性LCVP技术对围术期肾功能的影响。方法择期全麻下肝右叶切除术患者30例,ASAⅠ或Ⅱ级,随机均分为LCVP组和对照组。LCVP组患者通过严格输液控制、利尿、应用小剂量硝酸甘油等方法使肝叶切除术期间CVP调控在0～5cmH2O范围,对照组CVP维持在6～12cmH2O范围。分别于术前24h(T0)、手术结束即刻(T1)、术后24h(T2)、术后72h(T3)、术后120h(T4)抽取外周静脉血及留取尿液测定血、尿α1-MG浓度。结果两组患者肝叶切除术后各时点血α1-MG均低于麻醉前(P<0.05),但组间比较差异无统计学意义。两组患者各时点尿α1-MG组内比较差异均无统计学意义,T1时LCVP组尿α1-MG低于对照组(P<0.05)。结论LCVP对肝叶切除术患者围术期的肾功能无不良影响;与传统方法比较,LCVP可能对肝叶切除术患者术中的肾功能有一定的保护作用。

Objective To study the effects of low central venous pressure（I.CVP） on renal function by observing the changes of the concentrations of serum α1- microglobulin（α1-MG） and urine α1-MG. Methods Thirty ASA I or Ⅱ patients with right liver tumor undergoing hepatic lobectomy were randomly divided into two groups of group LCVP and group C with 15 cases each. The CVP was maintained at 0-5 cmH20 by strictly limiting fluid infusion, and infusion furosemide and glyceryl trinitrate before completing the resection and maintained at 6-12 cm H20 by fluid resuscitation after completing the resection in group LCVP, and was maintained at 6-12 cm H20 by normal transfusion in group C. Serum α1-MG and urine α1-MG were determined at five time points of one day before operation （T0）, at the end of operation （T1）, 24 h （T2）, 72 h（T3） and 120 h after operation（T4 ）. Results Serum α1-MG was significantly lower at T1 , T2, T3 and T4 than that at T0, in two groups, but there was no significantly difference between the two groups. Urine α1-MG was significantly lower in group LCVP than that in group C at T1. Conclusion Controlled LCVP has no significant adverse effect on renal function. Compared with the conventional method, the controlled LCVP may have a positive effect on renal function in the patients undergoing hepatic lobectomy.