复杂肝叶切除术中控制性低中心静脉压CLCVP的有效性观察

目的探讨复杂肝叶切除术中控制性低中心静脉压(CLCVP)的有效性。 方法选取2015年9月至2017年9月120例施行复杂肝叶切除术的原发性肝癌患者进行前瞻性研究。按随机数字化法分为常规组和CLCVP组。常规组术中给予常规中心静脉压控制( 6～12 cmH₂O)，CLCVP组术中≤5 cmH₂O。使用SPSS19.0统计软件进行数据处理，术中术后各项指标、肝肾功能指标、术前、术中、术后1 h及24 h的血红蛋白(HGB)用表示，采用独立t检验；计数资料比较采用χ²检验，以P<0.05为差异有统计学意义。 结果CLCVP组术中术后状况显著优于常规组。常规组术中、术后1 h、术后24 h的HGB含量均低于CLCVP组同期水平(P<0.05)。术后1 d、4 d、7 d两组ALT、AST水平均较术前显著上升，CLCVP组术后1 d、4 d显著低于常规组(P<0.05)。两组TBIL、BUN、Cr水平术后组间比较差异均无统计学意义(P>0.05)。 结论在复杂肝叶切除术中应用CLCVP技术能有效降低术中出血量，对肝功能影响较小。

Effectiveness of controlled low central venous pressure (CLCVP) in complex hepatic lobectomy

ObjectiveTo investigate the effectiveness of controlled low central venous pressure (CLCVP) in complex hepatic lobectomy. MethodsA prospective study was conducted in 120 patients with primary hepatocellular carcinoma who underwent complex lobectomy from September 2015 to September 2017. The patients were divided into conventional group and CLCVP group according to random digitization method. Conventional control of central venous pressure (6~12 cmH₂O) was given in the conventional group, while controlled low central venous pressure (≤5 cmH₂O) was given in the CLCVP group. SPSS19.0 statistical software was used for data processing. The intraoperative and postoperative indicators, liver and kidney function indicators, preoperative, intraoperative, 1h and 24h hemoglobin indicators were expressed by , and compared with independent t test. The counting data were compared by χ² test, P<0.05 showed significant difference. ResultsThe patients’ intraoperative and postoperative status of CLCVP group was significantly better than that of conventional group. Compared with pre-operation, the hemoglobin content in both groups decreased significantly during operation and after operation, and the hemoglobin content in conventional group was lower than that in CLCVP group at the same time (P<0.05). The levels of ALT and AST in the two groups increased significantly on the 1st, 4th and 7th day, which in the CLCVP group were significantly lower than those in the conventional group on the 1st and 4th day after operation (P<0.05). There was no significant difference in TBIL, BUN and Cr levels between the two groups after operation (P>0.05). ConclusionThe application of CLCVP in complex hepatic lobectomy can effectively reduce the amount of bleeding during operation, and has less effect on liver function.