低中心静脉压对肝叶切除术病人的血液保护效应

BLOOD-SAVING EFFECT OF LOW CENTRAL VENOUS PRESSURE IN PATIENTS UNDERGOING HEPATIC LOBECTOMY

目的:评价肝叶切除术病人应用低中心静脉压技术的血液保护效应。方法:择期行肝叶切除术的肝癌病人40例,随机分为两组(n=20):对照组(Ⅰ组)和低中心静脉压组(Ⅱ组),麻醉方法均为硬膜外复合全麻。Ⅰ组术中按1.5∶1输注晶体液和胶体液;Ⅱ组术中输注乳酸钠林格液1mL/kg/h,维持CVP 1-5cm H2O,术中静脉输注去甲肾上腺素维持MAP≥70 mmHg。分别于术前(基础状态)、手术开始、肝叶切除前即刻、肝叶切除后10min、术毕时及术后7d测定血红蛋白(Hb)、白细胞(WBC)、谷丙转氨酶(GPT)和肾功能指标,并记录各时段输液量和尿量;记录术中失血、输血情况和术后并发症的发生情况。结果:与Ⅰ组比较,Ⅱ组术中WBC、GPT、失血量、异体输血量、肝叶切除前输液量、尿量较低,术中Hb及肝叶切除后输液量和尿量较高(P<0.05)。肾功能、总输液量和尿量差异无统计学意义(P>0.05)。所有病人术后未见并发症发生。结论:肝叶切除术中应用低CVP技术能明显减少术中失血量和异体输血,且具有良好的安全性。

Objective： To evaluate the blood -saving effect of low central venous pressure （CVP） in patients undergoing hepatic lobectomy. Methods：Forty patients undergoing hepatic lobectomy for hepatocorcinoma under epidural combined with general anesthesia were divided into 2 groups （ n = 20） ; control group（ Ⅰ ） and low CVP. Group I received crystal and colloid in a ratio of 1.5：1 during operation ; while in group Ⅱ low CVP was induced and maintained by anesthesia and received Ringer＇s solution 1mL/kg/h. Hb, WBC count, glutamic- pyruvic transaminase（GPT） and renal function （BUN, Cr） were determined before operation（baseline） ,at the beginning of operation, immediately before and 10 min after liver lobe was removed, at the end of operation and 7d after operation. Urine output, intraoperative blood loss and blood transfusion and complications were recorded. Results：In group Ⅱ , WBC count and GPT level were significantly lower; the amount of fluid infused and urine output before hepatic lobe resection and allogeneic blood transfusion during operation were less; Hb and the amount of fluid infused and urine output after hepatic lobe resection were higher in group Ⅱ than group I.Conclusion： The low CVP is safe, which can decrease intraoperative blood loss and aUogeneic blood transfusion.