急性等容血液稀释联合低中心静脉压对肝癌手术中血流动力学及氧代谢的影响

摘要

Objective To investigate the effects of acute normovolemic hemodilution (ANH)combined with controlled lower central venous pressure (LCVP) on hemodynamics and oxygen metabolism during hepatectomy for hepatocellular carcinoma.Methods Sixty patients undergoing hepatectomy for hepatocellular carcinoma were randomly divided into three groups:ANH group (group A),combined ANH and LCVP group (group AC) and LCVP group (group C),with 20 patients in each group.The mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP),cardiac output (CO),systematic vascular resistance (SVR),lactate (Lac) concentration,oxygen delivery(DO2),consumption of oxygen(VO2) and oxygen extraction ration(ERO2)were recorded before ANH (T0),before CLCVP (T1),at 30 minutes after CLCVP(T2),after lesion excision (T3),and at the end of operation (T4).Results In group AC and group C,HR at T2/T3 was significantly higher than that at T0 or T1 (P＜0.05).The CVP at T2/T3 in group AC or group C was significantly lower than that at T0 in group A(P＜0.05).The SVR and DO2 at the four time points in group AC or group C were significantly lower than those at T1 in group A (P＜0.05).Conclusion ANH combined with LCVP can stabilize hemodynamics without effect on oxygen metabolism during hepatectomy for hepatocellular carcinoma.%目的 研究肝癌切除手术应用急性等容血液稀释(ANH)联合控制性低中心静脉压(LCVP)对血流动力学及氧代谢的影响.方法 将60例择期行肝癌切除术患者按随机数字表法分为3组:ANH组(A组)、ANH+LCVP组(AC组)和LCVP组(C组),每组20例.观察各组气管插管后ANH前(T0)、ANH后CLCVP前(T1)、CLCVP后30 min(T2)、切除病灶后(T3)和术毕(T4)各时间点的MAP、HR、CVP、CO、外周循环阻力(SVR)及动脉血乳酸(Lac)浓度的变化、氧供(DO2)、氧耗(VO2)和氧摄取率(ERO2).结果 T2、T3时AC组和C组HR明显快于T0、T1时(P＜0.05)；T2、T3时AC组和C组CVP明显低于T0时A组；T1-T4时AC组和C组SVR和DO2则显著低于T1时A组(P＜0.05).结论 肝癌切除手术应用ANH联合控制性低中心静脉压可维持稳定的血流动力学,且不影响机体氧代谢.