控制性低中心静脉压对右半肝切除术患者术后重要脏器功能的影响

Influences of controlled low central venous pressure(CLCVP) on the postoperative functions of major organs in the patients undergoing right hemihepatectomy

目的评价控制性低中心静脉压(CLCVP)对右半肝切除术患者术后肝、肾以及心、肺功能的影响。方法 60例需行右半肝切除术的原发性肝癌患者随机分为4组:A组为无肝门阻断肝癌切除(A1组未行CLCVP,A2组行CLCVP);B组为肝门阻断肝癌切除(B1组未行CLCVP,B2组行CLCVP)。所有患者于T0(麻醉前)、T1(A组为切肝前,B组为阻断肝门前)、T2(A组为切肝后,B组为开放肝门后1h)、T3(术后24h)时间点取动脉血行血气分析;T0和T3取静脉血检测心、肝、肾功能;记录术中失血量、尿量、补液总量、红细胞入量等。结果行CLCVP者术中失血量、尿量、补液总量和红细胞入量均低于未行CLCVP者。4个时间点4组A-aDO2、RI、BUN、Cr及TnT水平组间比较差异无统计学意义。T3时4组CK-MB均升高,B1组CK-MB变化值低于其他3组(P=0.037);4组T3时AST及ALT均显著升高,A1组升高小于其他3组(P分别为0.002、0.018)。结论右半肝切除术患者行CLCVP能显著减少术中补液总量;对非肝门阻断者可减少其红细胞用量及出血量、尿量,但对肝门阻断者无明显影响;CLCVP对心、肺及肾功能无明显影响,但对术后肝功能可能有一定影响。

Objective To investigate the influences of controlled low central venous pressure（CLCVP） on the cardiopulmonary and hepatorenal functions of patients undergoing right hemihepatectomy. Methods Sixty patients with hepatocellular carcinoma were randomly divided into 4 groups. Group A were those without hepatic portal occlusion （A1 not given CLCVP, A2 given CLCVP） and group B were patients under hepatic portal occlusion （B 1 not given CLCVP, B2 given CLCVP）. The volume of fluid infusion, RBC, blood loss and urine were recorded. The arterial blood was drawn before anesthesia（T0）, pre-hepatectomy（T1）, post- hepatectomy（T2）, 24 hours after operation（T3） in group A, and before anesthesia（TO）, pre-occlusion（T1）, post-occlusion（T2）, 24 hours after operation（T3）in group B. Blood-gas analysis, cardiac enzymes and hepatorenal function were tested. Results The volume of fluid infusion, RBC, blood loss and urine of patients with CLCVP were statistically lower than those of patients without CLCVP（P 〈0.05）. There were no statistical differences of A-aDO2, RI, BUN, Cr and TnT among the four groups on T0,T1,T2,T3. CK-MB on T3 was statistically increased and the variations in group B1 were lower than those in the other three groups（P=0.037）. AST and ALT were statistically increased on T3 in four groups, and the elevations in group A 1 was lower than those in the other three groups（P=0.002,P=0.018, respectively）. Condusions CLCVP can effectively decrease the volume of fluid infusion during the operation, RBC and blood loss in patients undergoing right hemihepatectomy, and has no influences on cardiopulmonary and renal functions. More attention should be paid to increased liver enzymes of the patients.