控制性低中心静脉压在肝癌切除术中的应用

Application of controlled low central venous pressure in the hepatectomy for hepatocellular carcinoma

目的观察低中心静脉压（LCVP）对肝癌切除手术失血量和肝肾功能的影响。方法40例行肝叶切除术的原发性肝癌患者随机分为两组，低中心静脉压组（LCVP组）20例和正常中心静脉压组（NCVP组）20例，LCVP组在肝实质完全离断过程中控制中心静脉压（CVP）在0～5cmH2O，NCVP组CVP维持在6～12cmH2O。观察两组患者肝实质离断时失血量及比较术后肝肾功能变化。结果LCVP组术中失血量为（222±98）ml，NCVP组术中失血量为（426±197）ml，LCVP组术中失血量明显少于NCVP组（P〈0．05），两组间术后肝肾功能比较，差异无统计学意义（P〉0．05）。结论低中心静脉压可减少肝癌切除术中的出血量，对肝肾功能的影响小。

Objective To investigate the effects of low central venous pressure（LCVP） on blood loss and hepatorenal function during hepatectomy for hepatocellular carcinoma（HCC）. Methods Forty patients with HCC were randomly divided into two groups, normal central venous pressure group （NCVP, n = 20） and LCVP group （n = 20）. The central venous pressure （CVP） of LCVP group patients was maintained less than 5 cm H2O during hepatic parenchymal transection phase of surgery, while the NCVP group with normal CVP（6 -12 cm H2O）. The volume of blood loss and changes of hepatorenal function were compared between the two groups. Results The volume of blood loss in the LCVP group was （222 ±98 ） ml, which was significantly less than that of the NCVP group [ （426 ±197 ） ml, P 〈 0. 05 ]. There was no significant difference in hepatorenal function between the two groups （ P 〉 0. 05 ）. Conclu- sions With the maintenance of CVP ≤5 cm H2O, blood loss during hepatic parenchymal transection is markly decreased, and it has no detrimental effect on hepatorenal function.