CAJ | 학술논문

目的评价控制性低中心静脉压(CLCVP)用于不同类型肝切除术患者的血液保护效应.方法择期行肝切除术患者90例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄37～76岁,体重40～75kg.根据手术方式和术中是否实施CLCVP将其分为6组(n=15):正常CVP的标准肝叶或肝段切除术组、半肝切除术组、不规则肝部分切除术组(NCLCVP1-3组)和CLCVP下标准肝叶或肝段切除术组、半肝切除术组、不规则肝部分切除术组(CLCVP1-3组).CLCVP1-3组切皮后通过调整体位、限制性输液和静脉输注硝酸甘油等措施维持CVP≤5 cm H2O,同时静脉输注去甲肾上腺素,维持MAP≥60 mm Hg,直至肝切除后.NCLCVP1-3组术中维持CVP6～12 cm H2O.记录术中出血量和输血量.结果与NCLCVP1-3组比较,CLCVP1-3组出血量均减少(P＜0.05);与NCLCVP3组比较,CLCVP3组输注红细胞量减少,术中出血量＜ 200 ml的构成比升高,出血量＞1000 ml的构成比降低(P＜0.05).结论 CLCVP 可减少不同类型肝切除术患者术中出血量,该效应在不规则部分肝切除术中尤为明显.
목적 평개공제성저중심정맥압(CLCVP)용우불동류형간절제술환자적혈액보호효응.방법 택기행간절제술환자90례,성별불한,ASA분급Ⅰ혹Ⅱ급,년령37～76세,체중40～75kg.근거수술방식화술중시부실시CLCVP장기분위6조(n=15):정상CVP적표준간협혹간단절제술조、반간절제술조、불규칙간부분절제술조(NCLCVP1-3조)화CLCVP하표준간협혹간단절제술조、반간절제술조、불규칙간부분절제술조(CLCVP1-3조).CLCVP1-3조절피후통과조정체위、한제성수액화정맥수주초산감유등조시유지CVP≤5 cm H2O,동시정맥수주거갑신상선소,유지MAP≥60 mm Hg,직지간절제후.NCLCVP1-3조술중유지CVP6～12 cm H2O.기록술중출혈량화수혈량.결과 여NCLCVP1-3조비교,CLCVP1-3조출혈량균감소(P＜0.05);여NCLCVP3조비교,CLCVP3조수주홍세포량감소,술중출혈량＜ 200 ml적구성비승고,출혈량＞1000 ml적구성비강저(P＜0.05).결론 CLCVP 가감소불동류형간절제술환자술중출혈량,해효응재불규칙부분간절제술중우위명현.
Objective To investigate the blood-saving effect of controlled low central venous pressure (CLCVP) in different types of hepatectomy.Methods Ninety ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 37-76 yr,weighing 40-75 kg,undergoing elective hepatectomy,were divided into 6 groups according to the surgical approach and whether CLCVP was used during surgery (n =15 each):CLCVP1-3 groups and nonCLCVP1-3 groups (NCLCVP1-3 groups).The standard hepatectomy,half liver resection and irregular hepatectomy were performed in CLCVP1-3 groups,respectively,with CLCVP.The standard hepatectomy,half liver resection and irregular hepatectomy were performed in NCLCVP1-3 groups,respectively,without CLCVP.In CLCVP1-3 groups,from skin incision to the end of liver resection,CVP was maintained ≤ 5 cm H2 O through adjustment of the position,fluid restriction and iv infusion of nitroglycerin,and norepinephrine was infused simultaneously to maintain mean arterial pressure ≥ 60 mm Hg.In NCLCVP1-3 groups CVP was maintained at 6-12 cm H2O.Intraoperative blood loss and blood transfusion were recorded.Results Compared with NCLCVP1-3 groups,intraoperative blood loss was significantly decreased in CLCVP1-3 groups (P ＜ 0.05).Compared with NCLCVP3 group,the amount of blood transfusion was significantly decreased,the constituent ratio of intraoperative blood loss ＜ 200 ml was increased,and the constituent ratio of intraoperative blood loss ＞ 1000 ml was decreased in group CLCVP3 (P ＜ 0.05).Conclusion CLCVP can decrease the intraoperative blood loss and blood transfusion in patients undergoing irregular hepatectomy.