低中心静脉压对肝叶切除患者失血及肝肾功能影响.docVIP

低中心静脉压对肝叶切除患者失血及肝肾功能影响 　 作者：余健 印红梅 张军 郑浩 陈益君 高文灿 【摘要】 目的： 观察低中心静脉压(LCVP)对肝叶切除手术失血量和肝肾功能的影响。方法： 36例择期肝叶切除患者随机分为两组： LCVP组(n=17)和正常中心静脉压组(NCVP,n=19)。LCVP组在肝实质完全离断过程中控制中心静脉压（CVP）在0～5 cmH2O，NCVP组CVP维持在6～12 cmH2O。观察两组患者术中总失血量、围术期输血例数，比较术后肝肾功能变化。结果： LCVP组和NCVP组术中失血量分别为(515±212) ml和(714±267) ml(Plt;0.05)，围术期分别有2例和8例输库血200～800 ml(Plt;0.05)；NCVP组1例患者术后第3天出现急性肾衰竭，但两组间血浆尿素氮（BUN）和肌酐（Cr）比较差异无统计学意义(Pgt;0.05)；术后1周两组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)均明显升高(Plt;0.01, Plt;0.05)，但第7天时LCVP组AST低于NCVP组(Plt;0.05)。结论： 低中心静脉压可减少肝叶切除术中的出血和输血量，对肝肾功能的影响小。 【关键词】 低中心静脉压； 肝叶切除术； 失血； 肝肾功能 　　［Abstract］ Objective: To investigate the effects of low central venous pressure(LCVP) on blood loss and hepatorenal function during hepatic resection. Methods： Thirtysix consecutive patients for elective major heptic resections were randomly divided into two groups, normal central venous pressure group(NCVP, n=19) and LCVP group(n=17). The central venous pressure(CVP) of LCVP group patients was maintained less than 5 cmH2O during hepatic parenchymal transection, while the NCVP group with normal CVP(6～12 cmH2O). The volume of blood loss and transfusion rate, changes of hepatorenal function were compared between the two groups. Results： The volume of blood loss and transfusion rate in the LCVP group（515±212）ml were significantly less than that of the NCVP group(714±267) ml，Plt;0.05. There were no marked difference in renal function between two groups, and the AST, ALT during postoperation were elevated obviously in both groups(Plt;0.01，Plt;0.05).But the AST of LCVP group were lower than the NCVP group(Plt;0.05) in the 7th day. Conclusion： LCVP was beneficial for reducing blood loss and blood infusion during hepatic resection, and had less effect on hepatorenal function. 　　［Key words］ low central venous pressure； hepatic resection； blood loss； hepatorenal function 　　部分肝叶切除目前仍然是临床上治疗肝脏占位的主要方法之一。由于肝脏组织脆弱、供血系统和血管分布较为复杂，术中不可避免地会出现大量出血，而在第一肝门阻断的情况下，出血主要来源于肝静脉系统。近来有报道［1］术中采用低中心静脉压技术(low centralvenous pressure,LCVP)