多巴酚丁胺联合硝酸甘油在实施控制性低中心静脉压技术中的应用效果探讨
Practical effect of dobutamine combined with nitroglycerin in controlled low central venous pressure technique
卢基成 1孙家铎 1卢呈祥 1许立新1
作者信息
摘要
目的 探究多巴酚丁胺联合硝酸甘油在实施控制性低中心静脉压(CLCVP)技术中的应用效果及其对患者血流动力学的影响.方法 50例肝部分切除(切除≥2个肝叶)患者,随机分为N组(24例)和D组(26例).在手术开始至切肝及止血完成阶段,N组使用硝酸甘油维持中心静脉压(CVP)<5 cm H2O(1 cm H2O=0.098 kPa),D组使用多巴酚丁胺联合硝酸甘油维持CVP<5 cm H2O.比较两组手术情况[手术时间、肝切除后(T4)和术毕(T5)输液量、尿量、术中出血量],CVP、心脏指数(CI),术野等级,血红蛋白(Hb)、红细胞比容(HCT)水平,肝、肾功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)、尿素氮(BUN)].结果 D组手术时间(222.8±81.6)min较N组的(277.1±61.3)min短,T5 输液量(2946.1±398.6)ml及术中出血量(223.0±115.5)ml较N组的(3233.5±444.3)、(404.8±219.6)ml少(P<0.05);两组T4 输液量及尿量比较无差异(P>0.05).与N组比较,D组在手术开始后 15 min(T2)时的CVP明显低于N组(P<0.05);诱导后(T1)、肝切除开始(T3)、T4 时D组CVP与N组比较无统计学意义(P>0.05);两组CVP在T2、T3、T4 时均较T1 低(P<0.05),在T5 时恢复至接近T1 水平(P>0.05).D组在T3 时的CI明显高于N组(P<0.05);D组在T1、T2、T4、T5 时的CI与N组比较无统计学差异(P>0.05);N组在T1～T4 时CI组内比较无统计学意义(P>0.05),在T5 时CI较T1 时高(P<0.05);D组在T2、T3、T5 时CI较T1 时高(P<0.05),T4 时CI与T1 比较无统计学差异(P>0.05).D组术中术野等级优于N组,有统计学差异(P<0.05).D组在T4、T5 的Hb、HCT均较N组高(P<0.05);两组T1 时的Hb、HCT无统计学差异(P>0.05);两组患者Hb、HCT在T4 和T5 时均较T1 降低(P<0.05).两组术前及术后第 1、3、7 天ALT、AST、BUN、Cr比较,差异均无统计学意义(P>0.05);两组术后第 1、3、7 天BUN和Cr与术前比较,无统计学差异(P>0.05);两组ALT、AST在术后第 1、3 天均较术前增高(P<0.05),术后第 7 天与术前比较无统计学差异(P>0.05).结论 在实施CLCVP技术中应用多巴酚丁胺联合硝酸甘油可更有效降低CVP,维持循环稳定,并减少术中出血量.
Abstract
Objective To explore the practical effect of dobutamine combined with nitroglycerin in controlled low central venous pressure(CLCVP)and its influence on hemodynamics of patients.Methods A total of 50 patients with partial hepatectomy(resection of≥2 liver lobes)were randomly divided into group N(24 cases)and group D(26 cases).From the start of surgery to the completion of hepatectomy and hemostasis,group N used nitroglycerin to maintain central venous pressure(CVP)<5 cm H2O(1 cm H2O=0.098 kPa);group D used dobutamine combined with nitroglycerin to maintain CVP<5 cm H2O.Both groups were compared in terms of surgical conditions[operation time,infusion volume after hepatectomy(T4)and at the end of the surgery(T5),urine volume and intraoperative blood loss],CVP,cardiac index(CI),surgical field grade,hemoglobin(Hb)and hematocrit(HCT)levels,liver and kidney function indicators[alanine aminotransferase(ALT),aspartate transaminase(AST),creatinine(Cr),blood urea nitrogen(BUN)].Results Group D had shorter operation time of(222.8±81.6)min than(277.1±61.3)min in group N;group D had less infusion volume of(2946.1±398.6)ml at T5 and intraoperative blood loss of(223.0±115.5)ml than(3233.5±444.3)and(404.8±219.6)ml in group N(P<0.05).There was no difference in infusion volume at T4 and urine volume between the two groups(P>0.05).Compared with group N,CVP in group D was significantly lower than that in group N at 15 min after surgery(T2)(P<0.05).There was no significant difference in CVP between group D and group N after induction(T1),at the beginning of hepatectomy(T3)and T4(P>0.05).CVP in both groups at T2,T3,and T4 was lower than that at T1(P<0.05),and recovered to near T1 level at T5(P>0.05).CI in group D was significantly higher than that in group N at T3(P<0.05).There was no significant difference in CI between group D and group N at T1,T2,T4 and T5(P>0.05).There was no statistical significance in CI at T1-T4 in group N(P>0.05),but CI at T5 was higher than that at T1(P<0.05).Group D had a higher CI at T2,T3,and T5 compared to T1(P<0.05),while there was no statistically significant difference in CI at T4 compared to T1(P>0.05).The surgical field grade of group D was better than that of group N,with a statistical difference(P<0.05).Group D had higher Hb and HCT at T4 and T5 than those in group N(P<0.05).There were no significant differences in Hb and HCT at T1 between the two groups(P>0.05).Hb and HCT in both groups at T4 and T5 were lower than those at T1(P<0.05).There was no significant difference in ALT,AST,BUN and Cr between the two groups before surgery and on the 1st,3rd and 7th day after surgery(P>0.05).BUN and Cr at 1,3 and 7 days after surgery were not significantly different from that before surgery(P>0.05).ALT and AST in both groups were higher than those before surgery on the 1st and 3rd day after surgery(P<0.05),and there was no significant difference on the 7th day after surgery compared with that before surgery(P>0.05).Conclusion Application of dobutamine combined with nitroglycerin in CLCVP technique can more effectively reduce CVP,maintain circulatory stability and reduce intraoperative blood loss.
关键词
肝部分切除/多巴酚丁胺/硝酸甘油/控制性低中心静脉压技术/低中心静脉压Key words
Partial hepatectomy/Dobutamine/Nitroglycerin/Controlled low central venous pressure technique/Low central venous pressure引用本文复制引用
出版年
2024
NETL
NSTL
万方数据