控制性低中心静脉压技术在肝囊型包虫外囊完整摘除术中的应用效果及安全性

Effect and safety of controlled low central venous pressure technique on complete removal of hepatic cystic echinococcosis

目的探讨控制性低中心静脉压(CLCVP)技术在肝囊型包虫外囊完整摘除术中的应用效果及安全性。方法选取2019年11月至2021年9月在新疆医科大学第一附属医院行肝囊型包虫外囊完整摘除术的患者120例,采用随机数字表法分为对照组和观察组,各60例。对照组术中患者采用5~12 cmHO(1 cmHO=0.098 kPa)的正常中心静脉压(CVP)技术,观察组术中采用0~5 cmHO的CLCVP技术。比较2组患者术中术后相关指标。结果 观察组手术时间、第一肝门总阻断时间、术中出血量、术中输血率及阻断第一肝门5 min时的CVP短于/低于对照组[(142±30)min比(159±47)min、(21±5)min比(23±4)min、(99±68)ml比(179±117)ml、3.3%(2/60)比13.3%(8/60)、(1.7±0.9)cmHO比(9.0±1.7)cmHO],阻断第一肝门5 min时的心率明显快于对照组,差异均有统计学意义(均P<0.05)。2组患者手术均顺利完成。2组患者麻醉恢复室停留时间、术后住院天数、术后带管时间、术后恶心呕吐发生率、术后肺部感染发生率、术后第3天肝肾功能指标差异均无统计学意义(均P>0.05)。结论肝包虫外囊完整摘除术中应用CLCVP技术在保证手术安全的同时,可有效减少手术时间、第一肝门阻断时间、术中出血量及术中输血率,且不增加术后不良反应发生率,不影响术后恢复及术后肝肾功能。

Objective To investigate the effect and safety of controlled low central venous pressure(CLCVP) technique on complete removal of hepatic cystic echinococcosis. Methods Totally 120 patients who underwent complete removal of hepatic cystic echinococcosis in the First Affiliated Hospital of Xinjiang Medical University from November 2019 to September 2021 were selected. The patients were randomly divided into control group and observation group, with 60 cases in each group. The patients in the control group were treated with 5-12 cmHO normal central venous pressure(CVP) technique, and the patients in the observation group were treated with 0-5 cmHO CLCVP technique during operation. The related indexes during and after operation were compared between the two groups. Results The operation time, the total blocking time of the first hepatic portal, the amount of intraoperative bleeding, the intraoperative blood transfusion rate and the CVP at the time of blocking the first hepatic portal for 5 min in the observation group were shorter/lower than those in the control group[(142±30)min vs(159±47)min,(21±5)min vs(23±4)min,(99±68)ml vs(179±117)ml, 3.3%(2/60) vs 13.3%(8/60),(1.7±0.9)cmHO vs(9.0±1.7)cmHO], and the heart rate at the time of blocking the first hepatic portal for 5 min was significantly faster than that in the control group(all P<0.05). The operation was successfully completed in both groups. There were no significant differences in the duration in anesthesia recovery room, postoperative length of stay, postoperative tube time, postoperative nausea and vomiting rate, postoperative pulmonary infection rate and liver and kidney function indexes on the third day after operation between the two groups(all P>0.05). Conclusions The application of CLCVP technique in the complete removal of hepatic cystic echinococcosis can not only ensure the safety of the operation, but also effectively reduce the operation time, the blocking time of the first hepatic portal, the amount of intraoperative bleeding and the intraoperative blood transfusion rate, without increasing the incidence of postoperative adverse reactions and affecting the postoperative recovery and liver and kidney function.