米力农控制性低中心静脉压用于腹腔镜肝切除术的效果

Effect of controlled low central venous pressure with milrinone on laparoscopic hepatectomy

目的评价米力农控制性低中心静脉压用于腹腔镜肝切除术的效果。方法择期行腹腔镜肝切除术患者50例,性别不限,BMI 18~30 kg/m^(2),年龄18~64岁,ASA分级Ⅰ~Ⅲ级,Child-Pugh分级A或B级。采用随机数字表法分为2组(n=25):米力农组(M组)和硝酸甘油组(NG组)。手术开始后M组持续静脉泵注米力农0.5μg·kg^(-1)·min^(-1),NG组以硝酸甘油0.5μg·kg^(-1)·min^(-1)为起始剂量持续静脉泵注,维持CVP≤5 mmHg。于入室(T_(0))、切皮(T_(1))、开始切肝(T_(2))、切肝完成(T3)和术毕(T4)时记录MAP和HR,T_(1)~4时记录CVP、CI和SVV,采集颈内静脉血样,测定Hb,T_(1)和T4时测定血乳酸浓度,术后1、3和7 d时测定血清ALT、AST和Cr浓度。记录肝切面渗血评分、去甲肾上腺素使用量、出血量、术后恢复及术后7 d内并发症的发生情况。结果与NG组比较,M组T_(2),3时CI升高,T_(2)时CVP降低,肝切面渗血评分、出血量、去甲肾上腺素用量、血乳酸浓度降低,术后腹腔引流管停留时间缩短(P<0.05)。2组术后1、3和7 d时血清AST、ALT和Cr浓度及术后并发症发生率比较差异无统计学意义(P>0.05)。结论米力农降低腹腔镜肝切除术患者中心静脉压、减少出血量、维持循环功能稳定及组织灌注的效果优于硝酸甘油。

Objective To evaluate the effect of controlled low central venous pressure with milrinone on laparoscopic hepatectomy in the patients.Methods Fifty American Society of Anesthesiologists physical statusⅠ-Ⅲpatients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m^(2),of Child-Pugh grade A or B,undergoing elective laparoscopic hepatectomy,were divided into 2 groups(n=25 each)using a random number table method:milrinone group(group M)and nitroglycerin group(group NG).After the start of surgery,milrinone 0.5μg·kg^(-1)·min^(-1) was continuously infused in group M,and nitroglycerin was continuously infused with the initial dose of 0.5μg·kg^(-1)·min^(-1) to maintain central venous pressure(CVP)≤5 mmHg in group NG.Mean arterial pressure and heart rate were recorded on admission to the operation room(T_(0)),at skin incision(T_(1)),at the beginning of liver resection(T_(2)),at completion of liver resection(T3),at the end of operation(T4),and CVP,cardiac index and stroke volume variation were recorded at T_(1)-4.Internal jugular vein blood samples were collected to determine the concentrations of hemogloblin,blood lactate at T_(1) and T4,and serum alanine aminotransferase,aspartate aminotransferase and creatinine concentrations at 1,3 and 7 days after surgery.The score of blood oozing in hepatic surgical field,amount of norepinephrine used,blood loss,postoperative recovery and occurrence of complications within 7 days after operation were recorded.Results Compared with group NG,cardiac index was significantly increased at T_(2),3,the CVP was decreased at T_(2),the blood oozing score,blood loss,consumption of norepinephrine,and concentrations of blood lactate were decreased,and the postoperative drainage indwelling time was shortened in group M(P<0.05).There was no significant difference in the serum alanine aminotransferase,aspartate aminotransferase and creatinine concentrations and incidence of postoperative complications at 1,3 and 7 days after operation between the two groups(P>0.05).Conclusions Milrinone is better than nitroglycerin in decreasing central venous pressure,reducing blood loss,maintaining stable circulatory function and tissue perfusion in laparoscopic hepatectomy.