控制性低中心静脉压在腹腔镜肝切除术中的应用

Application of controlled low central venous pressure in laparoscopic hepatectomy

目的:探讨腹腔镜肝切除术中应用控制性低中心静脉压技术的可行性。方法:回顾分析2009年9月至2010年8月为58例患者施行肝切除术的临床资料,分别行腹腔镜肝切除术(23例)和开腹肝切除术(35例),术中应用控制性低中心静脉压技术,观察术中动脉氧分压、二氧化碳分压、氧饱和度、呼气末二氧化碳分压、出血量、总输液量等指标,及术前术后肝肾功能的变化。结果:两组患者动脉氧分压、二氧化碳分压、氧饱和度、呼气末二氧化碳分压及出血量、总输液量等差异无统计学意义(P>0.05),术前、术后肝肾功能组间比较差异无统计学意义(P>0.05)。结论:腹腔镜肝切除术中应用控制性低中心静脉压技术有效可行,但需加强术中麻醉管理和监测,加强对气体栓塞风险的认识和预防,以保证患者的安全。

Objective：To evaluate the feasibility of controlled low central venous pressure（CLCVP） in laparoscopic hepatectomy. Methods：During Sep.2009 and Aug.2010,23 cases of laparoscopic hepatectomy and 35 cases of open hepatectomy were treated by CLCVP.Their clinical records were retrospectively studied,including intraoperative PaO2,PaCO2,SpO2,PETCO2,the blood loss,total transfusion,changes of liver and renal function perioperatively. Results：Between the two groups,there was no statistically significant difference in PaO2,PaCO2,SpO2,PETCO2,the volume of blood loss and total transfusion（P0.05）.The changes of liver and renal function perioperatively were not significantly different between the two groups（P0.05）. Conclusions：CLCVP applied to laparoscopic hepatectomy is generally safe and feasible.It must be strengthened in the management and monitoring of anesthesia,improvement of the awareness and prevention of the air embolism risk.