腹腔镜肝切除术第一次肝门开放后低中心静脉压的预测因素

Predictive factors for low central venous pressure after the first hepatic inflow release during laparoscopic hepatectomy

目的探讨腹腔镜肝切除术患者第一次肝门开放后低中心静脉压(CVP)的独立预测因素并评价其预测价值。方法在既往一项重组人脑利钠肽(rhBNP)降低腹腔镜肝切除术第一次肝门开放后术野出血分级的前瞻性研究基础上,选择2021年8月至2022年2月腹腔镜肝切除术患者49例,男34例,女15例,年龄18~79岁,ASAⅠ—Ⅲ级。根据第一次肝门开放后CVP水平将患者分为两组:CVP≤5 mmHg组(n=17)和CVP>5 mmHg组(n=32)。收集临床资料,对术中第一次肝门开放后CVP的可能影响因素进行二次分析。采用二元Logistic回归分析筛选出CVP≤5 mmHg的独立预测因素,建立预测CVP≤5 mmHg发生率的列线图模型。通过受试者工作特征(ROC)曲线评价模型的准确性。结果多因素分析显示,输注rhBNP(OR=4.45,95%CI 1.03~19.47,P=0.046)和低基线CVP(OR=0.83,95%CI 0.71~0.96,P=0.013)是腹腔镜肝切除术第一次肝门开放后CVP≤5 mmHg的独立预测因素。该模型预测CVP≤5 mmHg发生率曲线下面积为0.772(95%CI 0.621~0.924),敏感性0.647,特异性0.844。结论输注rhBNP和低基线CVP是腹腔镜肝切除术患者第一次肝门开放后CVP≤5 mmHg的独立预测因素。

Objective To identify and evaluate the independent factors that predict low central venous pressure(CVP)after the first hepatic inflow release during laparoscopic hepatectomy.Methods The present study was a secondary analysis of a previous prospective study,49 patients underwent laparoscopic hepatectomy were selected from August 2021 to February 2022,34 males and 15 females,aged 18-79 years,ASA physical statusⅠ-Ⅲ,which investigated the improved effect of recombinant human brain natriuretic peptide(rhBNP)on hepatic field bleeding grade after the first hepatic inflow release during laparoscopic hepatectomy.The enrolled patients were divided into two groups based on their CVP values after the first hepatic inflow release:CVP≤5 mmHg group(n=17)and CVP>5 mmHg group(n=32).Clinical data from patients were collected,the potential predictive factors affecting CVP after the first hepatic inflow release were analyzed.Binary logistic regression analysis was used to screen out independent predictive factors and establish a nomogram model for predicting the occurrence of CVP≤5 mmHg after the first hepatic inflow release.The accuracy of the nomogram model was evaluated by receiver operating characteristic(ROC)curve.Results The multivariable analysis showed rhBNP infusion(OR=4.45,95%CI 1.03-19.47,P=0.046)and low baseline CVP value(OR=0.83,95%CI 0.71-0.96,P=0.013)were independent predictive factors for CVP≤5 mmHg after the first hepatic inflow release during laparoscopic hepatectomy.The ROC curve showed a good accuracy with an area under the curve of 0.772(95%CI 0.621-0.924),sensitivity being 0.647,and specificity being 0.844.Conclusion Our present study reveals that rhBNP infusion and low baseline CVP are independent predictive factors for CVP≤5 mmHg after the first hepatic inflow release during laparoscopic hepatectomy.