控制性低中心静脉压技术对腹腔镜肝切除术患者术后快速康复的影响

Effect of controlled low central venous pressure on rapid postoperative rehabilitation of patients undergoing laparoscopic hepatectomy

目的探讨控制性低中心静脉压(controlled low central venous pressure,CLCVP)技术对腹腔镜肝切除术患者术后快速康复的影响。方法选择2019年1月至2020年10月于徐州医科大学附属医院全麻下行腹腔镜肝切除术的患者66例,根据随机原则分为CLCVP组(n=33)与对照(NCVP)组(n=33),对照组患者术中正常输液,维持常规中心静脉压(central venous pressure,CVP),CVP在6~12 cmH_(2)O,CLCVP组术中采用控制性低中心静脉压技术,维持CVP在5 cmH_(2)O以下,比较两组患者的血气分析指标、肝肾功能及手术相关指标。结果CLCVP组患者的切肝时间、手术时间、术中出血量、总输液量均显著少于对照组,差异有统计学意义(P<0.05);CLCVP组患者手术后1天、3天的HCO_(3)^(-)水平明显高于对照组,碱剩余(BE)水平显著低于对照组,差异有统计学意义(P<0.05);CLCVP组患者手术后1天、3天的谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TB)水平均显著低于对照组,差异有统计学意义(P<0.05);两组患者手术后1天、3天的白蛋白(ALB)、尿素氮(BUN)、血肌酐(Scr)水平比较,差异无统计学意义(P>0.05)。结论在腹腔镜肝切除术中应用CLCVP技术可有效缩短切肝时间,降低患者失血量,维持机体酸碱平衡及氧化状态,动脉血气指标更佳,促进术后康复。

Objective:To investigate the effect of controlled low central venous pressure(CLCVP)on rapid postoperative rehabilitation of patients undergoing laparoscopic hepatectomy.Methods:sixty-six patients undergoing laparoscopic hepatectomy under general anesthesia in the Affiliated Hospital of Xuzhou Medical University from January 2019 to October 2020 were randomly divided into controlled low central venous pressure(CLCVP)group(n=33)and control group(NCVP)(n=33).The patients in the control group received normal infusion during operation,maintained conventional central venous pressure,and CVP was 6~12 cmH_(2)O,In CLCVP group,controlled low central venous pressure technique was used to maintain CVP below 5 cmH_(2)O.The blood gas analysis indexes,liver and kidney function and operation related indexes of the two groups were compared.Results:the time of liver resection and operation in the CLCVP group were significantly shorter than those in the control group,and the amount of intraoperative bleeding and total infusion were significantly lower than those in the control group(P<0.05);The level of HCO3-in CLCVP group was significantly higher than that in control group at 1 and 3 days after operation,and the level of BE was significantly lower than that in control group(P<0.05);The levels of ALT,AST and TB in the clcvp group were significantly lower than those in control group(P<0.05);There was no significant difference in the levels of ALB,BUN and SCR between the two groups at 1 and 3 days after operation(P>0.05).Conclusion:The application of CLCVP technology in laparoscopic hepatectomy can effectively shorten the time of hepatectomy,reduce the blood loss of patients,maintain the acid-base balance and oxidation state of the body,better arterial blood gas index and promote postoperative rehabilitation.