控制性低中心静脉压对肝叶切除术患者血流动力学及心肌损伤的影响

摘要

Objective To explore the effect of controlled low central venous pressure (LCVP) on hemodynamics and myocardial injury in patients undergoing hepatic lobectomy .Methods Forty patients planned to receive hepatic lobectomy were randomly divided into controlled LCVP group(Group L,n=20) and control group(Group N,n=20).In Group L,controlled LCVP was performed,the speed of liquid infusion was controlled strictly,and central venous pressure(CVP) maintained from 0 to 5 cmH2O during operation.In Group N,the traditional liquid administration was performed ,and CVP maintained from 6 to 12 cmH2O(the normal).At one minute before anesthesia, one minute before hepatic lobectomy ,one minute after hepatic lobectomy ,and one minute after operation ,the hemodynamic changes ,the intraoperative blood loss,and the volumes of blood transfusion and fluid transfusion were recorded in the two groups .The levels of serum creatine kinase isoenzyme MB(CK-MB) and cardiac troponin I(cTnI) were detected before operation,one minute before operation,and one minute,12 hours and 24 hours after operation .Results There were no statistical differences in the systolic blood pressure ,diastolic blood pressure,mean arterial pressure or heart rate between two groups (P>0.05).The intraopeartive blood loss,the volumes of blood transfusion and liquid infusion in Group L were significantly less those in Group L (P<0.05).There were no statistical differences in the level of CK-MB or level of cTnI between two groups (P>0.05).Conclusion Controlled LCVP can reduce the intraopeartive blood loss , the volumes of blood transfusion and liquid infusion significantly ,has no obvious effect on hemodynamics in the patients undergoing hepatic lobectomy ,and probably does not cause the myocardial injury .%目的：探讨实施控制性低中心静脉压（LCVP）对肝叶切除术患者血流动力学及心肌损伤的影响。方法将40例拟行肝叶切除术的患者随机分为控制性LCVP组（ L组）和对照组（ N组）各20例。 L组实施控制性LCVP，术中严格控制液体输注速度，将中心静脉压（ CVP ）维持0～5 cmH2 O；N 组则采用传统液体管理方法，术中将 CVP 维持于正常水平（6～12 cmH2 O）。记录两组患者麻醉前1 min、肝叶切除开始前1 min、肝叶切除开始后1 min及术后1 min血流动力学变化情况，记录两组患者术中出血量、输血量和输液量；并于术前、术前1 min、术后1 min、术后12 h和术后24 h检测患者血清肌酸激酶同工酶MB（ CK-MB）和肌钙蛋白（ cTnI）水平。结果两组间收缩压、舒张压、平均动脉压和心率比较，差异均无统计学意义（P＞0．05）。 L组术中出血量、输血量、输液量等均明显少于对照组（P＜0．05）。两组患者CK-MB和cTnI水平比较，差异均无统计学意义（P＞0．05）。结论控制性LCVP可明显减少肝叶切除术患者术中出血量、输血量及输液量，对肝叶切除术患者血流动力学影响不明显，且对心肌可能并没有损伤作用。