控制性低中心静脉压对肝叶切除术患者血液流变学的影响

Effects of low central venous pressure on hemorheology in patients undergoing hepatic lobectomy

目的探讨肝叶切除术中控制性低中心静脉压(LCVP)技术对患者血液流变学的影响。方法24例择期全麻下行肝叶切除术患者,随机均分为LCVP组(L组)和对照组(C组)。L组患者在肝脏实质完全离断前将CVP控制在0～5cmH2O,随后通过输液将CVP升至6～12cmH2O。C组CVP维持在6～12cmH2O。在麻醉前(T0)、麻醉后30min(T1)、肝叶切除结束即刻(T2)、手术结束即刻(T3)抽取静脉血测定血液流变学各指标。结果两组患者的血液粘度在T1～T3时均低于T0时(P<0.05或P<0.01)。L组全血低切粘度在T1～T3时高于C组,全血高切粘度、血浆粘度在T2时高于C组(P<0.05或P<0.01)。红细胞压积在C组T2、T3时、L组T3时明显下降,T2时L组高于C组。在T1、T2时L组红细胞聚集指数高于C组(P<0.01)。在T1、T2时L组红细胞变形指数明显低于C组(P<0.05或P<0.01)。结论在肝叶切除术中应用LCVP技术患者血液粘度较麻醉前降低。在LCVP期间血液粘度、红细胞聚集指数均较正常输液患者高,红细胞变形指数较正常输液患者低。

Objective To study the effects of low central venous pressure （LCVP） on hemorheology in patients undergoing hepatic lobectomy. Methods Twenty-four patients were divided into two groups of LCVP group （L） and control group （C）. The CVP was maintained at 0-5 em H2O by withholding of intravenous fluids and maintained at 6-12 cm H2O by fluid resuscitation after hepatic lobectomy in group L, which was maintained at 6-12 cm H2O all the time by normal transfusion in group C. The venous blood sample were taken for determination of hemorheologieal parameters just before anesthesia（T0 ）, at 30 min after anesthesia induction（T1 ）, immediately after completing the resection（before fluid resuscitation, T2 ） and at the end of surgical procedure （T3）. Results Compared with To ,the blood viscosity decreased at T1 ,T2 and T3 in two groups （P〈0.05 or P〈0.01）. The whole-blood viscosity at low shear rates at T1, T2 and T3, the whole blood viscosity at high shear rates and plasma viscosity at T2 were higher in group L than that in group C （P〈0. 05 or P〈0.01）. The hematocrit in group L was higher than that in group C at T2. The erythrocyte aggregation in group L at T1 and T2 was higher than that in group C （P〈0. 01）. At T1 and T2, the erythroeyte deformability in group L was lower than that in group C （P〈0. 05 or P〈0.01）. Conclusion The blood viscosity is decreased in patients undergoing hepatectomy with LCVP. The blood viscosity and erythroeyte aggregation are higher and the erythrocyte deformability was lower during LCVP than those during normal transfusion.