老年肝肿瘤患者术中控制性降压对肾功能的影响

Effects of Controlled Low Central Venous Pressure on Renal Function of Elderly Patients Undergoing Liver Neoplasm Operation

目的:探讨术中控制性低中心静脉压(CLCVP)对老年肝肿瘤手术患者肾功能的影响。方法:选择行肝肿瘤手术的老年患者62例,根据肾小球滤过率(GFR)分为2组:A组(GFR≥60ml/min),B组(GFR<60ml/min)。2组均在肝实质完全离断前将中心静脉压(CVP)控制在0～5cmH2O水平,术中监测HR、SBP和尿量。并于手术前、术后1、4、7d采血测尿素氮(BUN)、肌酐(Cr)、尿酸(UA)和半胱氨酸蛋白酶抑制剂C(Cys-C)。结果:2组患者术中HR、SBP、尿量比较无显著差异(P>0.05);2组患者术前肾功能各项指标比较差异有显著性(P<0.05);A组患者各项指标除Cys-C外术后和术前比较无显著差异(P>0.05);B组患者各项指标术后均较术前升高,P<0.05。结论:术前GFR<60ml/min的老年肝肿瘤患者术中应用CLCVP可能使围手术期肾功能损伤的风险增加。

Objective：To explore the effects of controlled low central venous pressure（CLCVP） on renal function of elderly patients undergoing liver neoplasm operation.Methods：Sixty-two elderly patients undergoing liver neoplasm operation were enrolled in the study.They were divided into two groups according to glomerular filtration rate（GFR）：group A（GFR ≥60ml/min） and group B（GFR60 ml/min）.Central venous pressure（CVP） was regulated between 0～5 cm H2O before abruptio of hepatic parenchyma in both groups.Heart rate（HR）,SaO2,systolic blood pressure（SBP） and urine volume were detected during the operation.Cr、BUN、UA and Cys-C were measured before operation and 1,4 and 7 days after operation.Results：There were no significant differences in HR,SBP and urine volume during the operation between the two groups（P0.05）;there were significant differences in serum concentrations of Cr,BUN,UA and Cys-C before operation between 2 groups（P0.05）.Except for Cys-C,those indexes were maintained stable before and after operation in patients of group A（P0.05）;but were higher after operation than pre-operation in patients of group B（P0.05）.Conclusions：Implementation of CLCVP during liver neoplasm operation in elderly patients whose GFR 60 ml/min might increase the risk of renal function injury.