CAJ | 학술논문

目的：：探讨控制性低中心静脉压( low central venous pressure, LCVP)技术对肝细胞肝癌( hepatocellular carcinoma, HCC)切除术患者围手术期肝功能的影响。方法：30例按美国麻醉医师协会( ASA)麻醉分级Ⅰ或Ⅱ级的HCC根治术患者随机分为低中心静脉压组( L组)和对照组( N组),各15例。 L组术中限制输液并静脉使用硝酸甘油和呋塞米,控制CVP在0~5mmH2 O之间；N组常规输液,控制CVP在5~10 cmH2 O。记录两组患者术前(T0)、手术结束时(T1)、术后第一天(T2)、第三天(T3)、第七天(T4)的血清谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶( AST)、总胆红素( T． BIL)、直接胆红素( D． BIL)、间接胆红素( I． BIL)、总蛋白( TP)、白蛋白( ALB)、球蛋白( GLO)、前白蛋白( PA)的值。结果：两组AST、ALT较术前均增高,在T2时刻达到峰值,在T2时刻L组的ALT、AST明显高于N组,组间比较差异有统计学意义(P <0．05),T3、T4时间点肝功能逐渐恢复正常,组间比较差异无统计学意义(P>0．05)。而两组T． BIL、 D． BIL、I． BIL、TP、ALB、GLO、PA手术前后各时点组间比较差异均无统计学意义(P>0．05)。结论：LCVP对HCC患者术后ALT、AST仅有短暂影响,术后一周可逐渐恢复,对术后肝脏合成和代谢功能影响不大。
목적：：탐토공제성저중심정맥압( low central venous pressure, LCVP)기술대간세포간암( hepatocellular carcinoma, HCC)절제술환자위수술기간공능적영향。방법：30례안미국마취의사협회( ASA)마취분급Ⅰ혹Ⅱ급적HCC근치술환자수궤분위저중심정맥압조( L조)화대조조( N조),각15례。 L조술중한제수액병정맥사용초산감유화부새미,공제CVP재0~5mmH2 O지간；N조상규수액,공제CVP재5~10 cmH2 O。기록량조환자술전(T0)、수술결속시(T1)、술후제일천(T2)、제삼천(T3)、제칠천(T4)적혈청곡안산안기전이매(ALT)、천동안산안기전이매( AST)、총담홍소( T． BIL)、직접담홍소( D． BIL)、간접담홍소( I． BIL)、총단백( TP)、백단백( ALB)、구단백( GLO)、전백단백( PA)적치。결과：량조AST、ALT교술전균증고,재T2시각체도봉치,재T2시각L조적ALT、AST명현고우N조,조간비교차이유통계학의의(P <0．05),T3、T4시간점간공능축점회복정상,조간비교차이무통계학의의(P>0．05)。이량조T． BIL、 D． BIL、I． BIL、TP、ALB、GLO、PA수술전후각시점조간비교차이균무통계학의의(P>0．05)。결론：LCVP대HCC환자술후ALT、AST부유단잠영향,술후일주가축점회복,대술후간장합성화대사공능영향불대。
Objective: To investigate the effect of controlled low central venous pressure(LCVP) during the sur-gery for hepatocellular carcinoma( HCC) on perioperative period liver function( including ALT、AST、T. BIL、D. BIL、I. BIL、TP、ALB、GLO、PA) . Methods:Thirty hepatocellular carcinoma patients of ASAⅠorⅡwere randomly divided into con-trolled low central pressure group (group L, n=15) and normal central pressure group (group N, n=15). Drugs (nitro-glycerin and furosemide) and limited fluid injection were used to keep CVP 0 to 5 cmH2 O in group L. While in group N, routine fluid administration was conducted,keeping CVP 5 to 10 cmH2 O. Liver functions of patients in both groups at the point of pre-operation (T0), completing the procedure (T1),postoperative Day1 (T2), postoperative Day3(T3)and post-operative Day7(T4) were recorded. Results:Alanine transaminase(ALT) and aspartate aminotransferase(AST) increased after operation comparing with those at T0 in both groups, and they all reached to the peak value at the point of T2 . ALT and AST were signficantly higher in group L than those in group N at T2(P<0. 05). However, at the point of T3 and T4, the liver function returned to the normal level gradually with no statistically significant difference between the two groups( P >0. 05). The level of T. BIL, D. BIL, I. BIL, TP, ALB, GLO and PA were not significantly different between these two groups at each time point( P >0. 05). Conclusion:LCVP has a dramatic short effect on AST and ALT after he-patic resection for hepatocellular carcinoma patients. The val-ue of AST and ALT could become normal gradually within one week after operation. LCVP has no obvious effect on synthesis and metabolism function of the liver.