控制性低中心静脉压技术在肝脏巨大肿瘤切除手术中的应用

Application of controlled low central venous pressure in large liver neoplasm surgery

目的评价控制性低中心静脉压技术在肝脏巨大肿瘤手术中应用的可行性。方法对25例择期行肝脏巨大肿瘤手术患者,从麻醉诱导到病灶切除并止血完成,通过限制液体输入、调节头高脚低体位及使用异氟醚和(或)硝酸甘油控制中心静脉压<5mmHg,在止血完成后通过快速输注晶体和胶体液使中心静脉压恢复到正常水平。记录术中出血量和输血量,术前和术后24h抽静脉血查肌酐和尿素氮。结果术中平均出血量(1150±639.8)ml,其中16例患者在术中输血,平均输血量(841±443.5)ml;术后24h患者肾功能与术前相比无明显变化(P>0.05)。结论在肝脏巨大肿瘤手术中采用控制性低中心静脉压技术是可行的,且对肾功能无明显损害。

Objective To evaluate the feasibility of controlled low central venous pressure application in large liver neoplasm surgery.Methods Clinical data about twenty-five patients undergoing large liver neoplasm surgery in our de-partment were analyzed.From the anesthesia induction to parenchymal dissection and hemostasis,central venous pres-sure lower than 5 mmHg was maintained in patients by regulating the dosage of transfusion,adjusting the reverse-Trende-lenberg position and using insoflurane and（or） nitroglycerin injection.After hemostasis were completed,the central venous pressure was restored to normal range by rapid crystalloid and colloid solutions transfusion.Volume of blood loss,blood transfusion and variance of renal function pre-operation and 24 h after operation of the patients were recorded.Results The volume of blood loss was（1150±639.8）ml,blood transfusion for（841±443.5）ml was needed by sixteen patients;and there was no significant difference between the two groups in variance of renal function 24 h after surgery（P 0.05）.Con-clusion The anesthetic technique of controlled low central venous pressure is practical in large liver neoplasm,and has no detrimental effects on renal function.