CAJ | 학술논문

目的：探讨在不同类型肝脏切除术中使用控制性低中心静脉压（CLCVP）对术中出血量和患者预后的影响。方法回顾分析自2011年1月至2012年12月在重庆医科大学附属第一医院实施的257例择期肝脏切除手术资料。手术方式分为半肝切除术、标准肝叶/段切除术和非规则性肝部分切除术。在肝脏分离和切除过程中接受CLCVP处理的患者分至CLCVP组。该组患者通过调整体位、限制性输液和静脉泵注硝酸甘油等措施保持中心静脉压（CVP）小于或等于5cmH2O，同时维持平均动脉压（MAP）大于或等于60mmHg。术中保持正常CVP水平的患者分至NCVP组，该组患者通过调整输液维持CVP于正常水平（6～12cmH2O）。比较两组患者在各类肝脏切除术中的出血量、输血量及术后住院时间等，评价手术类型对CLCVP血液保护效果的影响。结果CLCVP组的出血量、浓缩红细胞输注量以及术后住院天数与NCVP组比较，差异无统计学意义（P＞0．05）。在不规则肝部分切除术的患者中，CLCVP组术中出血量和浓缩红细胞输注量均明显低于NCVP组（P＜0．05），CLCVP组术中出血量少于200mL和不需输血的患者比例高于NCVP组（P＜0．05）。两组术后住院天数比较，差异无统计学意义（P＞0．05）。结论CLCVP的血液保护效果受到肝脏切除手术类型的影响，在不规则肝部分切除术中其减少出血的效果最显著。CLCVP对肝切除术患者术后住院时间无明显影响。
목적：탐토재불동류형간장절제술중사용공제성저중심정맥압（CLCVP）대술중출혈량화환자예후적영향。방법회고분석자2011년1월지2012년12월재중경의과대학부속제일의원실시적257례택기간장절제수술자료。수술방식분위반간절제술、표준간협/단절제술화비규칙성간부분절제술。재간장분리화절제과정중접수CLCVP처리적환자분지CLCVP조。해조환자통과조정체위、한제성수액화정맥빙주초산감유등조시보지중심정맥압（CVP）소우혹등우5cmH2O，동시유지평균동맥압（MAP）대우혹등우60mmHg。술중보지정상CVP수평적환자분지NCVP조，해조환자통과조정수액유지CVP우정상수평（6～12cmH2O）。비교량조환자재각류간장절제술중적출혈량、수혈량급술후주원시간등，평개수술류형대CLCVP혈액보호효과적영향。결과CLCVP조적출혈량、농축홍세포수주량이급술후주원천수여NCVP조비교，차이무통계학의의（P＞0．05）。재불규칙간부분절제술적환자중，CLCVP조술중출혈량화농축홍세포수주량균명현저우NCVP조（P＜0．05），CLCVP조술중출혈량소우200mL화불수수혈적환자비례고우NCVP조（P＜0．05）。량조술후주원천수비교，차이무통계학의의（P＞0．05）。결론CLCVP적혈액보호효과수도간장절제수술류형적영향，재불규칙간부분절제술중기감소출혈적효과최현저。CLCVP대간절제술환자술후주원시간무명현영향。
Objective To investigate the effect of controlled low central venous pressure(CLCVP) on blood loss and prognosis in different types of hepatectomy .Methods Two hundred and fifty seven patients underwent standard hepatectomy ,half liver resec‐tion or irregular partial hepatectomy from January 2011 to December 2012 in the First Affiliated Hospital of Chongqing Medical U‐niversity were retrospectively studied .Patients treated with CLCVP during hepatectomy were attributed to the CLCVP group .CVP of these patients were lowed to below 5 cm H2 O by minimizing fluid infusion and one or both of the following maneuvers :posture adjustment ,nitroglycerin administration .Alpha agonists were used when necessary to maintain the mean arterial pressure MAP at ≥60 mm Hg .Other patients been maintained with normal level of CVP by adjusting fluid administration were included in normal CVP group (NCVP) .Blood loss and transfusion volume ,length of hospital stay of the two groups were compared ,and the effects of different surgery type on CLCVP blood protection were evaluated .Results In the patients underwent standard hepatectomy or half liver resection ,intraoperative blood loss and transfusion were not statistically different between the two groups .While in the pa‐tients underwent irregular partial hepatectomy ,the CLCVP group suffered less blood loss and transfusion(P<0 .05) .Percentage of the patients with less than 200 mL blood loss and no transfusion of concentrated red cell in CLCVP group was higher than that of in NCVP group(P<0 .05) .Differences between the two groups in postoperative hospital stay were with no significance in all the operation types(P>0 .05) .Conclusion The efficiency of CLCVP on blood protection during hepatectomy is influenced by the sur‐gery type ,the blood protection is found to be significant only in irregular partial hepatectomy .No relationship was found between CLCVP and postoperative hospital stay in all types of hepatectomy .