控制性低中心静脉压对肝移植术中酸碱平衡的影响

Effect of controlled low central venous pressure on acid-base balance in liver transplantation

目的观察控制性低中心静脉压(CLCVP)对肝移植术中酸碱平衡的影响。方法 46例行非转流原位肝移植患者分为CLCVP组(L组)和正常CVP组(C组),分别于开腹前10 min(T1)、无肝前期60 min(T2)、无肝期30 min(T3)、新肝期5 min(T4)、30 min(T5)及60 min(T6)行动脉血气分析及电解质检测,并记录无肝期时间、手术总时间、术中出血量、输血量和5%碳酸氢钠(NaHCO3)用量。结果 T4～T6时L组pH、BE明显高于C组(P<0.05);T1～T6时L组血Ca2+水平高于C组(P<0.05);L组术中出血量和输血量明显低于C组(P<0.05)。两组无肝期时间、手术总时间5、%NaHCO3用量差异无统计学意义。结论非转流原位肝移植患者在无肝期和新肝期均有明显的酸中毒,CLCVP技术可以改善肝移植术中酸碱平衡紊乱。

Objective To investigate the influence of controlled low central venous pressure（CLCVP） on acid-base balance in liver transplantation. Methods Forty six patients undergoing non-bypass orthotopic liver transplantation were divided into CLCVP group（group L） and normal central venous pressure（CVP） group（group C）. Blood acid-base status and electrolytes were analyzed 10 min before operation, 60 min before cross-clamping of the portal vein, 30 min in anhepatic phase, 5 min, 30 min and 60 min after unclamping of portal vein. Time of anhepatic phase, blood lose, trarLsfusion and sodium bicarbonate were recorded. Results pH and BE was higher in group L than in group C at T4-T6 （P 〈0. 05）. plasma calcium in group L were higher than in group C from T1 to T6 （P 〈0. 05）. Volume of blood lose and transfusion were less in group L （P〈0. 05）. Conclusion There was evident acidosis in orthotopic liver transplantation without vent-venous bypass. CLCVP was effective in improving disturbance of acid-base balance .