不同水平控制性低中心静脉压技术用于腹腔镜肝切除术患者安全性及有效性研究
Safety and effectiveness of different levels of controlled low central venous pressure in patients undergoing laparoscopic liver resection
李莘 1马丽 2刘杰 1苏明星 1孟宇航 1王立金 1陈小兰 1孙立 3赵艳娟4
作者信息
- 1. 解放军总医院京北医疗区,北京 100096
- 2. 解放军总医院第七医学中心 麻醉科,北京 100010
- 3. 解放军总医院第六医学中心 心血管病医学部 麻醉与体外循环科,北京 100037
- 4. 北部战区总医院,辽宁 沈阳 110016
- 折叠
摘要
目的 探讨不同水平控制性低中心静脉压(CLCVP)对腹腔镜肝切除术(LH)患者的安全性及有效性,为CLCVP在肝胆外科领域的合理应用提供参考.方法 选取自2020 年1 月至2022 年12 月就诊于解放军总医院第七医学中心并行LH的137 例患者为研究对象.根据术中是否采用CLCVP技术及CLCVP的水平将患者分为3 组:A组(n =43)实施全入肝Prin-gle法,不采用CLCVP技术;B组(n =48)实施Pringle法联合CLCVP技术,中心静脉压(CVP)为1～2 cmH2 O;C组(n =46)实施Pringle法联合CLCVP技术,CVP为3～5 cmH2 O.比较3 组患者的切肝时间、出血量、尿量、总输液量;术前及术后 1、3 d的血气分析指标[动脉血氧饱和度(SaO2)、碳酸氢根(HCO-3)、碱剩余(BE)]及肝肾功指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮(BUN)、肌酐(Cr)].结果 B组、C组患者的切肝时间、出血量、尿量和总输液量明显少于A组,差异均有统计学意义(P＜0.05).术前及术后1、3 d,3 组患者的SaO2 比较,差异均无统计学意义(P＞0.05);术前,3 组患者的HCO-3 和BE水平比较,差异均无统计学意义(P＞0.05);术后1、3 d,C组患者的HCO-3 和BE水平高于A组、B组,差异有统计学意义(P＜0.05).术前,3 组患者的AST、ALT、BUN和Cr水平比较,差异均无统计学意义(P＞0.05);术后1、3 d,3 组的BUN和Cr水平比较,差异均无统计学意义(P＞0.05);术后1、3 d,C组的ALT和AST水平均低于A组、B组,差异有统计学意义(P＜0.05).结论 CLCVP技术可以减少LH术中出血量并缩短手术时间,且不影响患者血氧饱和度和肾功能,具有较好的安全性;当CLCVP控制在 3～5 cmH2 O时,对患者肝功能及酸碱平衡影响较小,术后恢复较快,且可以更好地维持体内酸碱代谢平衡.
Abstract
Objective To explore the safety and efficacy of different levels of controlled low central venous pressure(CLCVP)in pa-tients undergoing laparoscopic hepatectomy(LH),and to provide reference for the reasonable application of CLCVP in hepatobiliary surgery.Methods A total of 137 patients with concurrent LH were selected from the Seventh Medical Center of Chinese PLA General Hospital from January 2020 to December 2022.Patients were divided into 3 groups according to whether CLCVP technique was used and the level of CLCVP.Group A(n =43)received Pringle method without CLCVP technique.Group B(n =48)underwent Pringle method combined with CLCVP technology,and the central venous pressure(CVP)was 1-2 cmH2 O.Group C(n =46)underwent Pringle method combined with CLCVP technology,and the CVP was 3-5 cmH2 O.The time of liver resection,blood loss,urine volume and total infusion volume of the 3 groups were compared.Blood gas analysis indexes[arterial oxygen saturation(SaO2),bicarbonate(HCO-3),alkali residual(BE)]and liver and kidney function indexes[alanine transaminase(ALT),aspartate aminotransferase(AST),blood u-rea nitrogen(BUN),creatinine(Cr)]before and 1 and 3 days after surgery of the 3 groups were compared.Results The liver resec-tion time,blood loss,urine volume and total infusion volume in group B and group C were significantly lower than those in group A,and the differences were statistically significant(P＜0.05).There was no significant difference in SaO2 among 3 groups before surgery and 1 and 3 days after surgery(P＞0.05).Before surgery,there was no significant difference in HCO-3 and BE levels among3 groups(P＞0.05).The levels of HCO-3 and BE in group C were significantly higher than those in group A and group B on the 1st and3rd day af-ter surgery,with statistical significance(P＜0.05).Before surgery,there were no significant differences in AST,ALT,BUN and Cr lev-els among 3 groups(P＞0.05).On the 1st and 3rd day after operation,there were no significant differences in BUN and Cr levels a-mong the 3 groups(P＞0.05).The levels of ALT and AST in group C were lower than those in group A and group B on the 1st and 3rd day after operation,and the difference was statistically significant(P＜0.05).Conclusion CLCVP technology can reduce the a-mount of blood loss during LH operation and shorten the operation time,and does not affect the blood oxygen saturation and kidney function of patients,and has a good safety.When CLCVP is controlled at 3-5 cmH2 O,it has little effect on the liver function and acid-base balance of patients,and the postoperative recovery is faster,and the acid-base metabolic balance in vivo can be better maintained.
关键词
控制性低中心静脉压/腹腔镜肝切除术/临床疗效/安全性Key words
Controlled low central venous pressure/Laparoscopic hepatectomy/Clinical efficacy/Safety引用本文复制引用
基金项目
全军医学科技青年培育计划孵化项目(19QNP059)
出版年
2024
NETL
NSTL
万方数据