控制性低中心静脉压对肝叶切除术患者血小板功能的影响

Effect of the controlled low central venous pressure on platelet function in patients undergoing hepatic lobectomy

目的探讨肝叶切除术中控制性低中心静脉压（LCVP）技术对患者血小板功能的影响。方法择期全麻下行肝叶切除术患者66例，随机均分为LCVP组（L组）和对照组（C组）。L组患者在肝脏实质完全离断前将CVP控制在0～5cmH2O，同时维持MAP〉70mmHg，C组CVP维持在6～12cmH2O。分别于麻醉前（T0）、麻醉后30min（T1）、肝叶切除结束即刻（T2）、手术结束即刻（T3）抽取桡动脉血查凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）及血小板计数（Plt）；并抽取桡动脉血，采用Sonoclot分析仪测定激活凝血酶原时间（ACT）、凝血速率（CR）、血小板功能（PF）。记录术中晶、胶体液输入量、出血量和尿量。结果与T0时比较，两组患者T1、T2时ACT；T1～T3时PT明显缩短；T2时CR明显减慢，PF降低；T2、T3时Plt明显减少；而APTT明显延长（P〈0．05）。与C组比较．T3时L组PF明显升高；Plt明显增加（P〈0．05）；L组术中晶体输入量、出血量明显减少、手术时间明显缩短（P〈0．01）：而患者胶体输入量和尿量差异均无统计学意义。结论控制性低中心静脉压技术对肝叶切除患者血小板功能有一定的保护作用，对凝血功能无不良影响。

Objective To investigate the effect of controlled low central venous pressure on platelet function in patients undergoing hepatic lobectomy. Methods A total of sixty-six patients undergoing liver resection were randomly divided into low central venous pressure group （group L, n =33） and placebo group （group C, n=33）. In the group L, CVP was maintained at 0-5 cm H2O and mean arterial pressure （MBP） above 70 mm Hg during hepatectomy, and CVP was maintained at 6-12 cm H2O by normal transfusion in group C. The artery blood sample were taken for sonoclot coagulation and platelet function analysis and blood coagulation parameters just before anesthesia （T0）, at 30 rain after anesthesia induction （T1）, immediately after completing the resection （before fluid resuscitation, Te ） and at the end of surgical procedure （%）. Results Compared with To, ACT, PT, Pit decreased at T, ,Te and CR, PF decreased at T2 ; APTT decreased at 172 ,Ta in two groups, the difference between the groups was not statistically significant; PF, Pit at T3 were higher in the group L than that of the group C, There were no statistically significant differences in fibrinogen （FIB） and the point in time between the two groups. Conclusion Controlled low central venous pressure （LCVP） during hepatic lobectomy in patients with platelet function has a protective effect. no adverse effects on blood coagulation.