临床医学
臨床醫學
림상의학
CLINICAL MEDICINE
2014年
8期
120-122,128
,共4页
中心静脉压%肝下下腔静脉%血流阻断
中心靜脈壓%肝下下腔靜脈%血流阻斷
중심정맥압%간하하강정맥%혈류조단
Central venous pressure%Hepatic inferior venae cava%Blocked blood flow
目的：分析并评价血流阻断在家兔肝脏部分切除手术中的应用。方法取家兔为实验对象，分为四组，每组20只，分别对其进行Pringle法、半肝阻断法、半肝阻断+肝下下腔静脉阻断法阻断肝脏血流及空白对照（仅开腹，但不做其他处理），分别测量阻断前、后的中心静脉压，肝脏部分切除后的出血量（切除相同部位的肝脏，尽量保证其大小及肝脏断面的面积相等），阻断20 min后恢复肝脏血流30 min，分别测量阻断前后转氨酶的数值。对所取得的数据进行统计学分析。为了解肝下下腔静脉阻断对家兔的影响，另取家兔15只，全麻后开腹结扎其肝下下腔静脉（肾静脉以上），关腹后清醒麻醉，观察其存活情况及术后第7天的肝、肾功能变化。结果①除半肝阻断法外，其余方法中心静脉压显著下降。②三种阻断方法的出血量均较对照组减少，半肝阻断+肝下下腔静脉阻断法出血量最少。③三种阻断方法均对肝功能有损害，Pringle法损害最大，其余两种方法无明显差异。单纯结扎肝下下腔静脉对家兔无明显影响（麻醉清醒后可正常进食及活动），术前、术后的肝、肾功能变化差异无统计学意义。结论肝下下腔静脉联合半肝血流阻断在肝脏部分切除手术中可有效降低中心静脉压，减轻术中出血，同时不增加肝功能损害，是一种安全、有效的阻断方法。
目的：分析併評價血流阻斷在傢兔肝髒部分切除手術中的應用。方法取傢兔為實驗對象，分為四組，每組20隻，分彆對其進行Pringle法、半肝阻斷法、半肝阻斷+肝下下腔靜脈阻斷法阻斷肝髒血流及空白對照（僅開腹，但不做其他處理），分彆測量阻斷前、後的中心靜脈壓，肝髒部分切除後的齣血量（切除相同部位的肝髒，儘量保證其大小及肝髒斷麵的麵積相等），阻斷20 min後恢複肝髒血流30 min，分彆測量阻斷前後轉氨酶的數值。對所取得的數據進行統計學分析。為瞭解肝下下腔靜脈阻斷對傢兔的影響，另取傢兔15隻，全痳後開腹結扎其肝下下腔靜脈（腎靜脈以上），關腹後清醒痳醉，觀察其存活情況及術後第7天的肝、腎功能變化。結果①除半肝阻斷法外，其餘方法中心靜脈壓顯著下降。②三種阻斷方法的齣血量均較對照組減少，半肝阻斷+肝下下腔靜脈阻斷法齣血量最少。③三種阻斷方法均對肝功能有損害，Pringle法損害最大，其餘兩種方法無明顯差異。單純結扎肝下下腔靜脈對傢兔無明顯影響（痳醉清醒後可正常進食及活動），術前、術後的肝、腎功能變化差異無統計學意義。結論肝下下腔靜脈聯閤半肝血流阻斷在肝髒部分切除手術中可有效降低中心靜脈壓，減輕術中齣血，同時不增加肝功能損害，是一種安全、有效的阻斷方法。
목적：분석병평개혈류조단재가토간장부분절제수술중적응용。방법취가토위실험대상，분위사조，매조20지，분별대기진행Pringle법、반간조단법、반간조단+간하하강정맥조단법조단간장혈류급공백대조（부개복，단불주기타처리），분별측량조단전、후적중심정맥압，간장부분절제후적출혈량（절제상동부위적간장，진량보증기대소급간장단면적면적상등），조단20 min후회복간장혈류30 min，분별측량조단전후전안매적수치。대소취득적수거진행통계학분석。위료해간하하강정맥조단대가토적영향，령취가토15지，전마후개복결찰기간하하강정맥（신정맥이상），관복후청성마취，관찰기존활정황급술후제7천적간、신공능변화。결과①제반간조단법외，기여방법중심정맥압현저하강。②삼충조단방법적출혈량균교대조조감소，반간조단+간하하강정맥조단법출혈량최소。③삼충조단방법균대간공능유손해，Pringle법손해최대，기여량충방법무명현차이。단순결찰간하하강정맥대가토무명현영향（마취청성후가정상진식급활동），술전、술후적간、신공능변화차이무통계학의의。결론간하하강정맥연합반간혈류조단재간장부분절제수술중가유효강저중심정맥압，감경술중출혈，동시불증가간공능손해，시일충안전、유효적조단방법。
Objective To study the application of hepatic blood flow block in the liver excision surgery in rabbits. Methods Eighty rabbits were randomly assigned into 4 groups,receiving Pringle maneuver,hemihepatic vascular occlusion, hemihepatic vascular occlusion combined with infrahepatic IVC clamping,and a blank control( processing laparotomy only). In all cases,three parameters were measured:①CVP prior to and after vascular occlusion;②Blood loss after hepatectomy,where same part and same size of the liver were resected;③Liver function before blood flow exclusion for 20 minutes,and after 30 mi-nutes of reperfusion. Fifteen extra rabbits were operated to evaluate the effects of infrahepatic IVC clamping on liver and renal function. Infrahepatic and suprarenal IVC was ligated in laparotomy with general aneasthesia. Post-operative vital signs,liver and renal function were recorded for 7 days. Results ①CVP decreased significantly except in the hemihepatic vascular occlusion.②Blood loss during operation in three experiment groups were all less than the control group,the hemihepatic vascular occlusion combined with infrahepatic IVC clamping group was less than the others. ③Liver function was impaired in all three experiment groups. There was no significant difference was found between the second and third group,which were both better than the Pring-le maneuver group. At last,single ligation of infrahepatic IVC did not had any impact on rabbits. Conclusion Hemihepatic vas-cular occlusion combined with infrahepatic IVC clamping can effectively reduce the central venous pressure,and intraoperative hemorrhage in the liver excision surgery,without increase of the damage of liver function,is a safe and effective method for bloc-king blood flow.
