低中心静脉压联合Habib 4X应用对肝叶切除术中出血量的影响

Effect of low central venous pressure combined with Habib 4X on intraoperative bleeding during hepatic lobectomy

目的观察控制性低中心静脉压技术联合Habib4X射频止血切割器应用对肝叶切除术中出血量的影响。方法择期全麻下因肝血管瘤需行肝叶切除手术的患者80例,ASAⅠ或Ⅱ级,随机均分为控制性低中心静脉压联合Habib4X组(L组)和正常中心静脉压联合传统缝扎法组(C组)。L组在肝实质完全离断过程中将CVP控制在0～5cm H2O,C组维持CVP在6～12cm H2O。观察两组患者术中总出血量、输血量、输血例数、肝门阻断例数、肝实质离断时间和肝实质离断后及术后24h肾功能变化。结果 L组手术总出血量、输血量、输血率、肝门阻断率、肝实质离断时间明显低于C组(P<0.05)。两组患者尿量差异无统计学意义,肝实质离断后、术后24h肾功能无明显变化。结论控制性低中心静脉压技术联合Habib4X射频止血切割器应用可减少肝叶切除术出血量和输血量。

Objective To observe the effect of controlled low central venous pressure combined with Habib 4X on intraoperative bleeding during hepatic lobectomy.Methods Eighty ASA Ⅰ or Ⅱ patients scheduled for hepatectomy under general anesthesia were randomly divided into two groups：low central venous pressure combined with Habib 4X group（group L） and normal central venous pressure combined with traditional suture and ligation method group（group C）,40 cases of each group.The CVP in group L was controlled within 0-5 cm H2O during hepatic parenchymal dissection,while the CVP of group C was maintained at 6-12 cm H2O.The total amount of intraoperative bleeding and blood transfusion,the cases of transfusion,the cases of hepatic portal occlusion,the time of hepatic parenchymal dissection,and the renal function after dissection and 24 h after operation,were recorded in both groups.Results The total amount of bleeding and blood transfusion,the incidence of blood transfusion and portal occlusion,and the time of liver dissection in group L were significantly less than those in group C.There were no significant differences in the intraoperative urine volume,and no significant changes in the renal function after dissection or 24h after operation.Conclusion Controlled low central venous pressure technique combined with Habib 4X can reduce bleeding and transfusion during hepatic lobectomy.