检测校正左室射血时间联合应用多巴酚丁胺在肝癌切除术中管理的临床效果

Clinical Effect of Detection and Correction of Left Ventricular Ejection Time Combined with Dobutamine in Intraoperative Management of Patients with Hepatectomy

目的评价校正左室射血时间联合应用多巴酚丁胺在肝癌切除术中管理的应用效果。方法选择2022年5月-11月在沧州市中心医院择期拟行肝癌切除术的患者68例,采用随机数字表法分为食道超声组(S组)和食道超声联合多巴酚丁胺组(D组),每组34例。S组在手术开始至肝部分切除后止血完成静脉泵注硝酸甘油,D组在手术开始至肝部分切除后止血完成持续泵注多巴酚丁胺,并泵注硝酸甘油。比较入室(T0)、诱导后即刻(T1)、手术开始(T2)、肝门阻断时(T3)、肝部分切除后(T4)、术毕(T5)CVP、HR、MAP,T1~T5时SV、LVETc。T0、T5时氧供指数(DO2I)和氧摄取率估计值(O2ERe),以及术后不良事件发生情况。结果最终纳入64例患者。与S组相比,D组T2~T3时点CVP值降低,T2~T5时点SV值升高,术中失血量减少,而术中尿量明显增加,硝酸甘油使用总剂量较小,术中低血压发生率降低,术中心脏气体栓子发生率低(P<0.05)。结论食道超声检测LVETc联合应用多巴酚丁胺可保证肝部分切除术患者血流动力学稳定,同时减少了术中低血压及气栓发生率。

Objective To evaluate the clinical effect of correction of left ventricular ejection time combined with dobutamine in intraoperative management of patients undergoing hepatectomy.Methods A total of 68 patients undergoing elective hepatectomy for liver cancer in Cangzhou Central Hospital from May to November 2022 were selected and divided into esophageal ultrasound group(group S)and esophageal ultrasound combined with dobutamine group(group D)by random number table method,with 34 patients in each group.In group S,nitroglycerin was pumped intravenously from the beginning of the operation to the completion of hemostasis after partial hepatectomy.In group D,dobutamine was pumped continuously from the beginning of the operation to the completion of hemostasis after partial hepatectomy,and nitroglycerin was pumped.CVP,HR,MAP[at the time of entering operation room(T0),immediately after induction(T1),at the beginning of operation(T2),at the time of hepatic portal occlusion(T3),after partial hepatectomy(T4)and at the end of operation(T5)],SV,LVETc at T1-T5 were compared.Oxygen delivery index(DO2I)and estimated oxygen extraction rate(O2ERe)at T0 and T5,as well as postoperative adverse events were recorded.Results Finally,64 patients were included.Compared with group S,the CVP value was decreased at T2-T3,the SV value was increased at T2-T5,the intraoperative blood loss was decreased,the intraoperative urine volume was significantly increased,the total dose of nitroglycerin was decreased,the incidence of intraoperative hypotension was decreased,and the incidence of intraoperative cardiac gas embolism was decreased in group D(P<0.05).Conclusion Esophageal ultrasound detection of LVETc combined with dobutamine can ensure hemodynamic stability in patients undergoing partial hepatectomy,and reduce the incidence of intraoperative hypotension and air embolism.