控制性低中心静脉压在腹腔镜肝切除术中的应用

摘要

目的 探讨控制性低中心静脉压(controlled low central venous pressure,CLCVP)技术用于腹腔镜肝切除术的可行性.方法 回顾性分析武汉市中心医院肝胆胰外科2013年1月至2016年5月间实施的51例腹腔镜肝切除术病人,其中采用控制性低中心静脉压(腔镜+CLCVP组)23例,正常中心静脉压(normal central venous pressure,NCVP)(腔镜+NCVP组)28例.观察切肝过程中出血量、手术时间、术中输血量等指标,并监测术前术后肝、肾功能的变化.结果 腔镜+CLCVP组较腔镜+NCVP组切肝过程中出血量少[(574±107) ml比(979±379) ml],断肝时间少[(105±63) min比(143±85) min],术中输血量少[(425±238) ml比(946±738) ml],两组比较差异均有统计学意义(均P<0.05),两组病例间术前术后肝、肾功能比较差异均无统计学意义(均P>0.05).两组病人均未发生有临床意义的气体栓塞等并发症.所有病人均苏醒平顺.结论 CLCVP技术用于腹腔镜肝切除术有效可行,但必须加强术中麻醉管理和监测,以保证病人安全.%Objective To investigate the clinical significance of controlled low central venous pressure (CLCVP) in laparoscopic hepatectomy.Methods During Jan.2013 to May 2016,51 patients who underwent laparoscopic hepatectomy were enrolled and divided into two groups:23 cases were treated with CLCVP,and the rest 28 cases with normal CVP.The operative time of liver resection,the intra-operative blood loss,the volume of blood transfusion and changes of renal and hepatic functions were compared.Results In the CLCVP and control groups,the intra-operative blood loss was (574±107) mL and (979±379) mL,respectively;the operation time of liver resection was (105±63) min and (143±85) min,respectively;the volume of blood transfusion was (425±238) mL and (946±738) mL,respectively.The differences were statistically significant (P<0.05).There was no significant difference in perioperative renal and hepatic functions between the two groups (P>0.05).Conclusions CLCVP applied to laparoscopic hepatectomy is generally safe and feasible.Intensive care should be taken in the anesthesia.