CAJ | 학술논문

目的：观察控制性降压、控制性低中心静脉压（CVP）及控制性降压联合控制性低 CVP 对肝切除术患者术中出血量、肝门阻断时间及肝肾功能等的影响。方法将60例行肝切除术的肝癌患者按随机数字表法分为 A、B、C、D 4组，每组15例。4组患者均行气管插管全身麻醉。A 组术中采取控制性降压[控制平均动脉压（MAP）为8．00～10．67 kPa、CVP 为0．490～0．980 kPa]，B 组采取控制性低 CVP（控制 CVP 为0．098～0．392 kPa、MAP≥10．67 kPa），C 组采取控制性降压联合控制性低 CVP（控制 CVP 0．098～0．392 kPa、MAP 为8．00～10．67 kPa），D组为对照组（维持 CVP 为0．490～0．980 kPa、MAP≥10．67 kPa）。比较4组患者手术一般情况[术中出血量、肝门阻断时间、手术时间、术后血红蛋白（Hb）及血细胞比容（HCT）等指标]；术前，术后1、3 d 肝功能相关指标（血清胆红素、血浆清蛋白、凝血酶原）及肾功能相关指标[尿素氮（BUN）水平、肌酐（Cr）]的变化。结果A、B、C 3组术中出血量、肝门阻断时间及手术时间均低于 D 组，术后 Hb、HCT 显著高于 D 组（均 P ＜0．05）；C 组术中出血量、肝门阻断时间均低于 A、B 组，术后 Hb、HCT 均高于 A、B 组（均 P ＜0．05）。4组患者术前，术后1、3 d，肝、肾功能相关指标比较差异均无统计学意义（均 P ＞0．05）。结论控制性降压、控制性低 CVP 及控制性降压联合控制性低CVP 3种降压方式均可降低肝切除术患者术中出血量，缩短肝门阻断时间，但控制性降压联合控制性低 CVP 效果更为显著，且对术后肝、肾功能均无显著影响，临床应用安全。
목적：관찰공제성강압、공제성저중심정맥압（CVP）급공제성강압연합공제성저 CVP 대간절제술환자술중출혈량、간문조단시간급간신공능등적영향。방법장60례행간절제술적간암환자안수궤수자표법분위 A、B、C、D 4조，매조15례。4조환자균행기관삽관전신마취。A 조술중채취공제성강압[공제평균동맥압（MAP）위8．00～10．67 kPa、CVP 위0．490～0．980 kPa]，B 조채취공제성저 CVP（공제 CVP 위0．098～0．392 kPa、MAP≥10．67 kPa），C 조채취공제성강압연합공제성저 CVP（공제 CVP 0．098～0．392 kPa、MAP 위8．00～10．67 kPa），D조위대조조（유지 CVP 위0．490～0．980 kPa、MAP≥10．67 kPa）。비교4조환자수술일반정황[술중출혈량、간문조단시간、수술시간、술후혈홍단백（Hb）급혈세포비용（HCT）등지표]；술전，술후1、3 d 간공능상관지표（혈청담홍소、혈장청단백、응혈매원）급신공능상관지표[뇨소담（BUN）수평、기항（Cr）]적변화。결과A、B、C 3조술중출혈량、간문조단시간급수술시간균저우 D 조，술후 Hb、HCT 현저고우 D 조（균 P ＜0．05）；C 조술중출혈량、간문조단시간균저우 A、B 조，술후 Hb、HCT 균고우 A、B 조（균 P ＜0．05）。4조환자술전，술후1、3 d，간、신공능상관지표비교차이균무통계학의의（균 P ＞0．05）。결론공제성강압、공제성저 CVP 급공제성강압연합공제성저CVP 3충강압방식균가강저간절제술환자술중출혈량，축단간문조단시간，단공제성강압연합공제성저 CVP 효과경위현저，차대술후간、신공능균무현저영향，림상응용안전。
ABSTRACT:Objective To observe the effects of controlled hypotension,controlled low central venous pressure(CVP)and their combination on intraoperative blood loss,portal clamping time and hepatorenal function in patients undergoing hepatectomy.Methods Sixty patients who re-quired hepatectomy for liver cancer were randomly divided into four groups,with 15 patients in each group.All patients received general anesthesia and tracheal intubation.In addition,patients in group A,B,C and D were given controlled hypotension(mean arterial pressure(MAP),(8.00-10.67)kPa;CVP,(0.490-0.980)kPa),controlled low CVP(CVP,(0.098-0.392)kPa;MAP,≥10.67 kPa),controlled hypotension plus controlled low CVP(CVP,(0.098-0.392)kPa;MAP, (8.00-10.67)kPa)and maintained CVP(CVP,(0.490-0.980)kPa;MAP,≥10.67 kPa),respec-tively.Intraoperative blood loss,portal clamping time,operation time,and postoperative hemoglo-bin(Hb)level and hematocrit(HCT)were compared among the four groups.Furthermore,hepatic function indexes serum bilirubin and plasma albumin,and renal function indexes blood urea nitro-gen(BUN)and creatinine(Cr)were measured before operation and 1 and 3 days after operation. Results Compared with group D,intraoperative blood loss was reduced,portal clamping time and operation time were shortened,and postoperative Hb level and HCT were increased in group A,B and C(P < 0.05).Compared with group A or B,intraoperative blood loss was reduced,portal clamping time was shortened,and postoperative Hb level and HCT were increased in group C (P <0.05).No significant differences in hepatorenal function indexes were found among the four groups before operation and 1 and 3 days after operation(P >0.05).Conclusion Both controlled hypotension and controlled low CVP,especially their combination,can reduce intraoperative blood loss,shorten portal clamping time,and have no effect on hepatorenal function in patients undergo-ing hepatectomy.