目标导向液体治疗联合米力农在腹腔镜肝叶切除手术中实现控制性低中心静脉压的观察

Observation of Achieving Controlled Low Central Venous Pressure with Goal-directed Fluid Therapy Combined with Milrinone in Laparoscopic Hepatic Lobectomy

目的探讨目标导向液体治疗联合米力农在腹腔镜肝叶切除术中实现控制性低中心静脉压(controlled low central venous pressure,CLCVP)的效果。方法选取2021年08月至2023年11月昆明市第一人民医院行腹腔镜肝叶切除手术患者60例为研究对象,采用随机数字表法将其均分为2组,即对照组、实验组各30例。对照组采用严格控制液体治疗(输注3 mL/kg晶胶比为1∶1的液体),根据患情使用泵注Nitroglycerin实现CLCVP;实验组则采用以SVV 1%~9%为目标进行液体治疗(输注20 mL/kg晶胶比为1∶1的液体),并联合使用米力农实现CLCVP。记录2组手术视野满意率、出血量、血压变化、尿量和中心静脉压以及住院时间指标。结果实验组手术医生术中视野满意率高于对照组,差异有统计学意义(P<0.05);实验组术中总出血量、平均出血量均低于对照组,手术时间短于对照组,差异有统计学意义(P<0.05);2组在术前平均动脉压方面比较,差异无统计学意义(P>0.05);实验组在术中、术后平均动脉压均高于对照组,差异有统计学意义(P<0.05);2组在术中尿量方面比较,差异无统计学意义(P>0.05),但术后尿量实验组高于对照组,术中平均CVP值低于对照组,差异有统计学意义(P<0.05);实验组总住院时间、平均住院时间均短于对照组,差异有统计学意义(P<0.05)。结论在腹腔镜肝叶切除手术中,采用目标导向液体治疗联合米力农实现控制性低中心静脉压(CLCVP)的方法,相较于传统严格液体控制,显著减少术中出血,维持循环稳定,缩短手术与住院时间,提高手术医生视野满意率。

Objective To investigate the effect of goal-directed fluid therapy combined with milrinone in achieving controlled low central venous pressure(CLCVP)in laparoscopic hepatic lobectomy.Methods Sixty patients undergoing laparoscopic hepatectomy at the First People’s Hospital of Kunming City from August 2021 to November 2023 were selected as the study subjects.They were randomLy divided into two groups,with 30 cases in each group:the control group and the experimental group.The control group received strict fluid therapy(infusion of crystalloid at a ratio of 1∶1 at 3 mL/kg)and Nitroglycerin infusion to achieve CLCVP based on the patient’s condition.The experimental group received fluid therapy targeting SVV 1%~9%(infusion of crystalloid at a ratio of 1∶1 at 20 mL/kg)and milrinone was used in combination to achieve CLCVP.Surgical field satisfaction,blood loss,blood pressure changes,urine output,central venous pressure,and length of hospital stay were recorded for both groups.Results The intraoperative surgical field satisfaction of the experimental group was higher than that of the control group,with statistically significant differences(P<0.05);the total intraoperative blood loss and average blood loss in the experimental group were lower than those in the control group,and the surgical time was shorter than that of the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in preoperative mean arterial pressure between the two groups(P>0.05).The experimental group had higher mean arterial pressure both intraoperatively and postoperatively than the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in urine output between the two groups intraoperatively(P>0.05),but postoperatively,the urine output in the experimental group was higher than that in the control group.The average CVP value was lower in the experimental group than in the control group,with statistically significant differences(P<0.05).The total length of hospital stay and average length of hospital stay were shorter in the experimental group than in the control group,with statistically significant differences(P<0.05).Conclusion In laparoscopic liver resection surgery,the use of goal-directed fluid therapy combined with milrinone to achieve controlled low central venous pressure(CLCVP)significantly reduces intraoperative bleeding,maintains hemodynamic stability,shortens surgical and hospital stay,and improves surgeon’s satisfaction with surgical field compared to the traditional strict fluid control method.