控制性低中心静脉压在腹腔镜下肝切除手术中的应用

Application of controlled low central center venous pressure in laparoscopic hepatectomy

目的探讨控制性低中心静脉压(CLCVP)在腹腔镜肝切除手术中应用的可行性。方法选取2017年12月至2019年12月深圳市宝安中心医院(深圳大学第五附属医院)麻醉科收治的60例择期行腹腔镜肝切除术的患者,男31例,女29例,年龄(55.57±6.90)岁,年龄范围为38~64岁。采用随机数表法将所有患者随机分为CLCVP组和常规中心静脉压(NCVP)组,每组30例。观察两组患者平均切肝时间、平均术中出血量、平均输血量、输血例数,术前和术后1 d、术后3 d、术后6 d的血浆白蛋白、总胆红素、谷草转氨酶、谷丙转氨酶、血肌酐、血尿素氮的水平,以及两组患者术后是否有气体栓塞发生。结果CLCVP组平均切肝时间[(84.50±5.12)min]、平均出血量[(605.00±128.89)ml]、平均输血量[(366.67±57.74)ml]及输血例数(3例)均少于NCVP组[(102.53±6.76)min、(881.67±152.27)ml、(518.19±87.39)ml、11例],差异有统计学意义(P<0.05)。术前、术后1 d、术后3 d、术后6 d,两组患者的谷丙转氨酶、谷草转氨酶、总胆红素、血浆白蛋白、血尿素氮、血肌酐水平比较,差异均无统计学意义(P>0.05)。两组均未发生空气栓塞。结论CLCVP在腹腔镜肝切除手术中能明显减少平均切肝时间、平均出血量、平均输血量、输血例数,但不会对术后1 d、术后3 d、术后6 d的肝肾功能有明显的影响且不会增加发生空气栓塞的风险。

Objective To investigate the feasibility of controlled low central venous pressure(CLCVP)in laparoscopic hepatectomy.Methods A retrospective study was performed on 60 cases of patients who were admitted to Anesthesiology of Shenzhen Baoan Central Hospital(Fifth Affiliated Hospital of Shenzhen University)and underwent CLCVP from December 2017 to December 2019,including 31 males and 29 females,aged(55.57±6.90)years old,ranging from 38 to 64 years old.Patients were randomly divided into the CLCVP group and the normal central venous pressure(NCVP)group,with 30 cases in each group.Average liver resection time,intraoperative blood loss,mean blood transfusion volume,number of blood transfusions,plasma albumin(ALB),total bilirubin(TB),aspartate aminotransferase(AST),alanine aminotransferase(ALT),serum creatinine(SCR)and blood urea nitrogen(BUN)levels and whether air embolism occurred after surgery were observed between the two groups before,1 day,3 days and 6 days after surgery.Results The average liver resection time[(84.50±5.12)minutes],the average blood loss[(605.00±128.89)ml],the average blood transfusion volume[(366.67±57.74)ml]and the number of blood transfusions(3 cases)in CLCVP group were all lower than those in NCVP group[(102.53±6.76)minutes,(881.67±152.27)ml,(518.19±87.39)ml,11 cases],and the difference was statistically significant(P<0.05).There were no significant differences in ALT,AST,TB,ALB,BUN and SCR levels between two groups before,1 day,3 days and 6 days after surgery(P>0.05).No air embolism occurred in the two groups.Conclusion CLCVP in laparoscopic hepatectomy can significantly reduce the mean liver resection time,the mean blood loss,the mean blood transfusion volume and the number of blood transfusion cases,but it has no significant influence on the liver and kidney function at 1 day,3 days and 6 days postoperatively,and does not increase the risk of air embolism.