控制性低中心静脉压对腹腔镜肝癌切除术患者中心静脉血氧饱和度和乳酸的影响

Effect of controlled low central venous pressure on central venous oxygen saturation and lactic acid in patients undergoing laparoscopic hepatocellular carcinoma resection

中文关键词: 控制性低中心静脉压  中心静脉血氧饱和度  乳酸  肝癌切除术

英文关键词: Controlled low central venous pressure  Central venous oxygen saturation  Lactic acid  Hepatocellular carcinoma resection

中文摘要:

      
目的 探讨腹腔镜肝癌切除术中硝酸甘油控制性低中心静脉压（CLCVP）对患者术中中心静脉血氧饱和度（ScvO₂）和动脉血乳酸（Lac）的影响。
方法 选择择期行腹腔镜肝癌切除术患者50例，男27例，女23例，年龄36～64岁，BMI 18~25 kg/m²，ASA Ⅰ或Ⅱ级，采用随机数字表将患者随机分为两组：CLCVP组（L组）和对照组（C组），每组25例。L组在切肝前5 min通过静脉泵注硝酸甘油0.2～0.5 μg·kg^-1·min^-1，维持CVP≤5 cmH₂O；C组常规输液并维持CVP 6～12 cmH₂O。记录术中出血量、输液量和苏醒时间，记录切肝前15 min、切肝中10、40 min、切肝后30 min的ScvO₂、Lac、HR和MAP。记录术后不良反应的发生情况。
结果 与C组比较，L组术中出血量和输液量明显降低（P＜0.05）。与切肝前15 min比较，切肝中10、40 min，L组ScvO₂和MAP明显降低（P＜0.05）；切肝中10 min，L组HR明显增快（P＜0.05）。与C组比较，切肝中10、40 min，L组ScvO₂和MAP明显降低（P＜0.05）。两组苏醒时间、术后不良反应发生率差异无统计学意义。
结论 腹腔镜肝切除术中硝酸甘油CLCVP可有效减少术中出血，使ScvO₂下降，对Lac值无明显影响，且不增加不良反应。

英文摘要:

      
Objective To investigate the effect of controlled low central venous pressure (CLCVP) by nitroglycerin on central venous oxygen saturation (ScvO₂) and arterial lactic acid (Lac) during laparoscopic hepatocellular carcinoma resection.
Methods Fifty patients undergoing elective hepatocellular carcinoma resection, 27 males and 23 females, aged 36-64 years, BMI 18-25 kg/m², ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups: CLCVP group (group L) and control group (group C), 25 patients in each group. In group L, nitroglycerin was injected intravenously with 0.2-0.5 μg·kg^-1·min^-1 at 5 minutes before liver resection to controll central venous pressure (CVP) ≤ 5 cmH₂O, while CVP was maintained at 6-12 cmH₂O in group C. Intraoperative blood loss, infusion volume and recovery time were recorded. ScvO₂ and Lac, HR and MAP were recorded at 15 minutes before liver resection, 10 minutes and 40 minutes during liver resection, and 30 minutes after liver resection. The incidence of postoperative adverse reactions were also recorded.
Results The amount of intraoperative blood loss and infusion in group L were significantly lower than that in group C (P < 0.05). Compared with 15 minutes before liver resection, ScvO₂ and MAP of group L were significantly decreased than that at 10 and 40 minutes during liver resection (P < 0.05), HR of group L was significantly increased during 10 minutes of liver resection (P < 0.05). Compared with group C, ScvO₂ and MAP of group L were significantly decreased than that at 10 and 40 minutes after liver resection (P < 0.05). There were no significant differences in anesthesia recovery time and incidence of postoperative adverse reactions between the two groups.
Conclusion Nitroglycerin CLCVP can effectively reduce bleeding and decrease ScvO₂ during hepatocellular carcinoma resection, but has no significant effect on Lac value and does not increase adverse reactions.