肝移植术中应用控制性低中心静脉压技术对脑氧代谢的影响

Effects of controlled low central venous pressure on cerebral oxygen metabolism during liver transplantation

目的观察肝移植术中应用控制性低中心静脉压（CLCVP）技术对脑氧代谢的影响，探讨肝移植术中应用CLCVP技术的安全性。方法选择因终末期肝病接受肝移植的受者46例，将受者分为CLCVP组（CL组，23例）和正常中心静脉压（CVP）组（C组，23例），于手术开始前即刻（T1）、下腔和门脉阻断前即刻（T2）、无肝期30min时（T3）、新肝期30min时（Tt4）、新肝期2h时（T5）、新肝期24h时（T6），采集受者桡动脉和颈静脉血行血气分析，并计算动脉血氧含量（Ca02）、颈静脉血氧含量（cjv02）、动脉一颈静脉血氧含量差（Ca-jv02）、颈静脉血氧饱和度（sjv02）、脑氧摄取率（CE—RO2）及脑血流／脑氧代谢比值（CBF／CMR02）等指标。同时检测两组受者的血肌酐和尿素氮水平，并记录手术耗时、无肝期时间、红细胞和血浆输入量、输液总量、出血量及尿量等指标。结果T1、T2、T3、T4、T5及T6各时点，两组间Ca02、Cjv02、Ca-jvO、Sjv02、CER02、CBF／CMRO的差异无统计学意义（P〉0．05）；两组T3、T4、T5时CaOz、Cjv02、Ca-jv02、CER02均较T1和T2时显著降低（P〈0．05），而sjv（）2较T1和T2时显著增高（P〈O．05），T6时两组间和组内的差异均无统计学意义（P〉0．05）。两组受者手术耗时和无肝期时间均无显著差异（P〉O．05）。CL组术中出血量、红细胞和血浆输入量、输液总量均明显低于C组（P〈0．05），CL组术中尿量较C组显著增加（P〈O．05），两组间和组内血肌酐和尿素氮的差异均无统计学意义。结论肝移植术中应用CLCVP技术对脑氧代谢无不良影响，同时可显著减少术中出血量，增加术中尿量。

Objective To investigate the etfects ot controlled low central venous pressure （CLCVP） on cerebral oxygen metabolism during orthotopic liver transplantation （OLT）, and study the safety of CLCVP in OLT. Method Forty-six patients subject to OLT were randomly divided into CLCVP group （CL group） and CVP group （C group）. Blood samples were taken from radial artery and jugular simultaneously for blood gas analysis before operation （T1, baseline）, immediately blocking inferior vena and portal vein （T2）, 30 rain after anhepatic phase （T3）, 30 min after graft reperfusion （T4）, 2 b after graft reperfusion （T5）, and 24 h after graft reperfusion （T6）. Cerebral arterial oxygen content （CaO2）, jugular oxygen content （CjvO2）, cerebral arterial-venous oxygen content difference （Ca-jvO2）, cerebral oxygen extraction rate （CERO2）, and cerebral blood flow/ cerebral metabolic rate of oxygen （CBF/CMRO2） were calculated by the Fick formulae. Meanwhile, blood samples were taken from jugular simultaneously for serum creatinine （Cr） and urea nitrogen （BUN） a different time points. We also recorded the whole operation time, anhepatic phase time, volume of blood loss and transfusion, and urine volume. Results As compared with C group, CaO2, CjvO2, Ca-jvO2, SjvO2, CERO2 and CBF/CMRO2 in CL group were nearly not changed at different time pioints （P〉0. 05）, but in the same group, as compared with T1 and T2, the CaO2, CjvO2, Ca- jvO2 and CERO2 in T3, T4 and T5 were decreased significantly （P〈0. 05）, and the SjvO2 in T3, T4 and T5 was increased remarkably. The operation time and anhepatic phase time had no significant difference in both groups. As compared with C group, the volume of blood loss and transfusion in CL group were decreased （P〈0. 05）, and the urine volume in CL group CL was increased significantly （P〈0. 05）. Cr and BUN showed no significant difference in both groups and at the same time points of Cgroup and CL group. Conclusion CLCVP can decrease volume of blood loss and transfusion, increase urine volume during OLT, and it does not change the eerebral oxygen metabolism during OLT.