以中心静脉压为目标的容量控制对肝移植术后机械通气时间的影响

Influence of central venous pressure on mechanical ventilation time as goal of controlling fluid after liver transplantation

目的研究术后中心静脉压控制对肝移植患者机械通气时间的影响。方法采用单中心、随机、对照方法,纳入2012年2月-2013年10月肝移植术后住ICU患者36例,监测中心静脉压（CVP）,脉搏指示性连续心排量（PICCO）监测血流动力学参数,氧合指数,脱离呼吸机时间以及观察期间液体累计出入量,超声评估肺水。入ICU的患者根据随机分配的原则,经24 h容量调整后分为两组：目标中心静脉压为0～6 mm Hg的18例患者为常规组,目标中心静脉压为6～12 mm Hg的18例患者为控制组。结果与控制组比较,常规组脱离呼吸机时间缩短（11.6±0.6 h vs 16.7±0.7 h,P〈0.05）,胸内血容量指数（ITBVI）、血管外肺水指数（EVLWI）以及超声评估肺水肿分数降低（P〈0.05）;氧合指数常规组较控制组升高[（298.4±31.7）mm Hg vs（236.1±32.4）mm Hg,P〈0.05]。结论在肝移植术后第一个24 h内,将中心静脉压（CVP）控制在0~6 mm Hg有利于改善肺脏功能,缩短机械通气时间。

【Objective】 To research the influence of central venous pressure control on mechanical ventilation time after liver transplantation. 【Methods】 Prospective, randomized, controlled study was carried out in the Intensive Care Unit of the University Hospital. The 36 patients who underwent liver transplantation received the measure of CVP（central venous pressure）, PICCO（pulse indicated continuous cardiac output）,oxygenation index, and lung water in ICU from February 2012 to October 2013. The patients were divided into 2 groups according to whether or not CVP was more than 6 mm Hg after the first 24 h in ICU（group A from 0 to 6 mm Hg and group B from 6 to 12 mm Hg）. The mechanical ventilation time, fluid intake and output volume, oxygenation index, and lung water were evaluated by PICCO and ultrasound. 【Results】 In contrast to group B, group A had reduced the mechanical ventilation time [（11.6 ± 0.6） h vs（16.7 ± 0.7） h, P〈0.05], decreased intrathoracic blood volume index（ITBVI）, extravascular lung water index（EVLWI） and lung water scores（P〈0.05）, and increased oxygenation index [（298.4 ± 31.7） mm Hg vs（236.1 ± 32.4） mm Hg, P〈0.05]. 【Conclusion】 At the first 24 h after liver transplantation, controlling CVP to 0~6 mm Hg is better for improving the lung function and reducing the time of mechanical ventilation.