低中心静脉压技术在腹腔镜肝切除术中临床应用研究

摘要

Objective To evaluate the safety and value of low central venous pressure (CVP) in laparoscopic hepatectomy.Methods Thirty-six patients who underwent laparoscopic hepatectomy between Jan 2013 to June 2017 in our hospital were randomly assigned into the low CVP group (LCVP,18 cases) and normal CVP group (NCVP group,18 cases).During the parenchymal transection phase of surgery,CVP and mean atrial pressure were maintained between 0 and 5 mmH2O and ＞ 60 mmHg respectively in the LCVP group by adjusting position,limiting the fluid infusion and drugs.CVP of NCVP group was maintained between 6 to I2 cmH2O.The blood loss,the time of operation,the time of hepatic portal occlusion,the rate of air embolism and the postoperative renal function in the two groups were compared.Results The blood loss,operation time,the time of hepatic portal occlusion and hepatic CVP values in group LCVP were significantly lower than those in the NCVP group (P ＜ 0.05).The rate of air embolism and postoperative renal function in two groups were not statistically different (P ＞ 0.05).Conclusion LCVP in laparoscopic hepatectomy is safe and reduces blood loss,shortens the operation time and the time of hepatic portal occlusion.%目的 探讨低中心静脉压技术在腹腔镜肝切除术中应用价值及安全性.方法 将本院2013年01月～ 2017年06月实施腹腔镜肝切除术36例患者随机分为低中心静脉压组(low central venous pressure,LCVP组)18例和正常中心静脉组(normal central venous pressure,NCVP组)18例,LCVP组通过体位、限制补液及药物维持低中心静脉压(CVP) (0 ～5cmH2O),平均动脉压维持在60mmHg,NCVP组维持中心静脉压在(6～12 cmH2O),观察比较两组术中出血量、手术时间、第一肝门阻断时间,空气栓塞发生率和术后肾功能变化.结果 LCVP组术中出血量、手术时间、第一肝门阻断时间及切肝时平均CVP值均低于NCVP组,差异有统计学意义(P＜0.05),两组术中空气栓塞发生率及术后肾功能的差异无统计学意义(P＞0.05).结论 腹腔镜肝切除术中应用低中心静脉压技术在保证手术安全的同时,可有效减少术中出血量,缩短手术时间及第一肝门阻断时间.