间歇低气道压力通气联合低中心静脉压技术在腹腔镜肝切除术中的应用:前瞻性随机对照研究

Clinical Application of Intermittent Low Airway Pressure Ventilation Strategy Combined With Low Central Venous Pressure in Laparoscopic Liver Resection:a Prospective Randomized Controlled Trial

目的探讨间歇低气道压力(low airway pressure,LAWP)通气联合低中心静脉压(low central venous pressure,LCVP)技术在腹腔镜肝切除术中的应用价值及安全性。方法选择我院2014年1月~2019年12月采用LCVP技术行腹腔镜肝切除术50例,随机分为LAWP组和正常气道压力(normal airway pressure,NAWP)组,每组25例,比较2组术中出血量、手术时间、第一肝门阻断时间,不同时点包括离断肝实质前5 min(T1)、离断肝实质后5 min(T2)、10 min(T3)、15 min(T4)平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)和气道压(airway pressure,AWP)。结果LAWP组术中出血量明显少于NAWP组[中位数250(200~350)ml vs.330(220~450)ml,Z=-3.156,P=0.002];手术时间[(147.0±19.9)min,明显短于NAWP组(180.6±19.1)min(t=-6.081,P=0.001);第一肝门阻断时间中位数18(15~30)min,明显短于NAWP组30(15~35)min(Z=-4.235,P=0.001);2组术后住院时间差异无统计学意义(P>0.05)。在离断肝实质期间各时间点CVP组间差异有统计学意义(P<0.05),CVP和MAP不同时间点及组间与时间交互作用差异均有统计学意义(P<0.05)。结论腹腔镜肝切除术中应用间歇LAWP通气策略联合LCVP技术在保证手术安全的同时,可有效降低切肝时中心静脉压,减少术中出血量,缩短手术时间及第一肝门阻断时间。

Objective To evaluate the safety and value of intermittent low airway pressure ventilation strategy combined with low central venous pressure(LCVP)in laparoscopic liver resection.Methods Fifty patients who underwent implementation of LCVP and laparoscopic liver resection between January 2014 to December 2019 in our hospital were randomly assigned into the low airway pressure group(LAWP,25 cases)and normal airway pressure group(NAWP group,25 cases).The blood loss,time of operation,time of vascular inflow occlusion,mean arterial pressure(MAP),CVP and airway pressure(AWP)in the two groups were compared and monitored at four separate time points,namely 5 min before(T1),5 min(T2),10 min(T3),and 15 min(T4)after parenchymal transection.Results The LAWP group had less intraoperative blood loss[250(200-350)ml vs.330(220-450)ml,Z=-3.156,P=0.002],shorter operative time[(147.0±19.9)min vs.(180.6±19.1)min,t=-6.081,P=0.001],shorter time of vascular inflow occlusion[18(15-30)min vs.30(15-35)min,Z=-4.235,P=0.001]than the NAWP group,but there was no statistically significant difference in postoperative hospital stay between the two groups(P>0.05).There were significant differences in CVP and MAP between groups at different time points during liver parenchyma transection(P<0.05),and there were significant differences at different time points and interaction between groups and time(P<0.05).Conclusion Intermittent low airway pressure ventilation strategy combined with LCVP in laparoscopic liver resection is safe,which reduces blood loss and shortens the operation time and time of vascular inflow occlusion.