SHCC患者RFA治疗中进行性低血压发生的风险研究

Study on the Risk of Progressive Hypotension During RFA in SHCC Patients

目的探讨SHCC患者RFA治疗中进行性低血压发生的风险,并提出预防性建议。方法所有病例均经过病理活检确诊为SHCC。于麻醉前(记为T0时刻),麻醉完成时(记为T1时刻),手术开始时(记为T2时刻),手术开始后10 min(记为T3时刻),手术开始后30 min(记为T4时刻),手术结束时(记为T5时刻),患者苏醒时(记为T6时刻)记录患者的舒张压和收缩压。并分析病灶数目、最大病灶直径、患病年限以及病理学分化等级与患者的舒张压和收缩压的关联性。结果围手术期不同时段测得的血压值结果显示,舒张压围手术期不同时段测得的结果差异不具有统计学意义(P>0.05);但收缩压围手术期不同时段测得的结果差异具有统计学意义(P<0.05),手术开始前30 min总体呈现下降趋势,手术开始后30 min起总体呈现上升趋势。由于手术开始后30 min SHCC患者的收缩压水平开始发生逆转,分析病灶数目、最大病灶直径、患病年限以及病理学分化等级与手术开始后30 min SHCC患者的收缩压水平的关联性。结果显示,病灶数目、最大病灶直径以及病理学分化等级与手术开始后30 min SHCC患者的收缩压水平,其中病灶数目越多、最大病灶直径越大以及病理学分化越低的患者手术开始后30 min SHCC患者的收缩压水平越低(P<0.05)。结论SHCC患者RFA治疗中进行性低血压的根本解决途径是提高术者的手术技巧,减少出血量;此外,低血压在一定范围内建议密切监测,不建议立即给予升压药物。

Objective To explore the risk of progressive hypotension in patients with SHCC during RFA treatment,and to put forward preventive countermeasures.Methods All cases were confirmed as SHCC by pathological biopsy.The treatment was carried out on the premise that the attending doctor confirmed that the patients met the indications for RFA treatment and their families agreed.The diastolic and systolic blood pressure of the patient were recorded before anesthesia(recorded as t0 time),at the completion of anesthesia(recorded as T1 time),at the beginning of the operation(recorded as T2 time),10 min after the beginning of the operation(recorded as T3 time),30 min after the beginning of the operation(recorded as T4 time),at the end of the operation(recorded as T5 time),and when the patient woke up(recorded as T6 time).The relationship between the number of lesions,the largest lesion diameter,the number of years of illness and the grade of pathological differentiation and the diastolic and systolic blood pressure was analyzed.Results of different blood pressure values around the measured time display operation period,diastolic pressure difference around the results of different operative period measured was not statistically significant(P>0.05);but systolic pressure around the results measured at different times of operation of difference was statistically significant(P<0.05),after the start of the operation the overall downward trend in 30 min before and after the surgery began showing an overall upward trend after 30 min.Because of the patient's systolic blood pressure level 30 min SHCC was reversed after surgery began,we analyze the relevance of the number of lesions,the largest lesion diameter,age and prevalence of pathological differentiation levels and systolic blood pressure levels in patients after the start of 30 min SHCC surgery.The results showed that the number of lesions,lesion diameter and maximum systolic blood pressure 30 min SHCC patients after surgical pathology grade of differentiation begins,wherein the more the number of lesions,and the larger the maximum diameter of the lower lesion pathology in patients undergoing differentiation of patients after starting 30 min SHCC the lower levels of systolic blood pressure(P<0.05).Conclusions The fundamental solution to progressive hypotension in RFA treatment of SHCC patients is to improve the surgeon's surgical skills and reduce the amount of bleeding.In addition,close monitoring of hypotension is recommended within a certain range,and it is not recommended to give booster drugs immediately.