控制性低中心静脉压联合无创血流动力学监测在精准肝切除手术中的应用效果

Application Effect of Controlled Low Central Venous Pressure Combined with Noninvasive Hemodynamic Monitoring in Precise Liver Resection

目的:探讨控制性低中心静脉压技术(CLCVP)联合无创血流动力学监测(NICOM)在精准肝切除手术中的应用效果。方法:选择2020年1月-2021年5月于新余市人民医院进行择期精准肝切除术治疗的患者60例,采用随机数字表法分为对照组与观察组,每组30例。两组均进行精准肝切除治疗,对照组术中进行常规操作,观察组采用CLCVP联合NICOM。比较两组临床指标、血流动力学、肝功能指标变化。结果:相较于对照组,观察组手术时间、肝门阻断时间均更短,术中补液量、出血量、输血量均更少,差异均有统计学意义(P<0.05)。两组麻醉诱导前5 min(T_(0))血流动力学指标对比,差异均无统计学意义(P>0.05);观察组肝脏病灶切除后5 min(T_(1))、手术结束时(T_(2))血流动力学指标均低于对照组,差异均有统计学意义(P<0.05)。两组术前、术后24 h肝功能指标水平比较,差异均无统计学意义(P>0.05)。结论:在精准肝切除手术中应用CLCVP联合NICOM效果较好,能维持患者血流动力学稳定,缩短肝门阻断及手术时间,减少术中出血量、补液量、输血量,且对肝功能影响较小,值得临床广泛应用。

Objective:To investigate the effect of controlled low central venous pressure(CLCVP)combined with noninvasive hemodynamic monitoring(NICOM)in precise liver resection.Method:A total of 60 patients who underwent selective precise liver resection in Xinyu People’s Hospital from January 2020 to May 2021 were selected and divided into two groups by random number table method,30 patients in each group.Precision liver resection was performed in both groups,routine operation was performed in the control group,and CLCVP combined with NICOM was used in the observation group.The changes of clinical indicators,hemodynamic and liver function indexes were compared between two groups.Result:Compared with the control group,the observation group had shorter operation time and hilar occlusion time,and less intraoperative fluid infusion,blood loss and blood transfusion,the differences were statistically significant(P<0.05).There were no significant differences in hemodynamic indexes at 5 min before anesthesia induction(T_(0))between two groups(P>0.05),the hemodynamic indexes of the observation group at 5 min after resection(T_(1))and the end of surgery(T_(2))were lower than those of the control group,the differences were statistically significant(P<0.05).There were no significant differences in liver function indexes before operation and 24 h after operation between two groups(P>0.05).Conclusion:CLCVP combined with NICOM has a good effect in precise liver resection,which can maintain stable hemodynamic of patients,shorten hilar occlusion and operation time,and reduce the amount of blood loss,fluid infusion and blood transfusion,and has little influence on liver function,it is worthy of widespread clinical application.