PPV指导术中液体治疗对行肝部分切除术治疗的肝内胆管结石患者术后并发症发生的影响*

目的 探讨脉压变化（PPV）指导术中液体治疗对肝内胆管结石行肝部分切除患者术后并发症的影响。方法 2008年3月~2017年3月我院收治的肝内胆管结石患者260例,在行腹腔镜肝部分切除术过程中,134例采用PPV指导的液体治疗,126例对照组常规处理。采用Logistic回归分析影响患者术后并发症发生的因素。结果 对照组术中潮气量为（7.5±1.3） mL/kg,明显低于干预组【（8.2±1.4） mL/kg,P<0.05】;手术开始时,对照组平均动脉压（MAP）和红细胞压积分别为（97.3±15.4） mmHg和（28.6±5.8）%,与干预组比,差异显著【分别为（87.4±17.2） mmHg和（34.2±7.4） %,P<0.05】;对照组手术时间和中心静脉压（CVP）分别为（414.7±164.8） min和[9.4（5.4,10.2） mmHg,与干预组比,差异显著【分别为（321.5±124.7） min和10.3（6.3,12.8）mmHg,P<0.05】;术后24 h,干预组MAP和CVP分别为（81.8±13.5）mmHg和8.3（6.2,10.1） mmHg,显著低于对照组【分别为（85.6±14.8）mmHg和11.4（8.1,14.7） mmHg,P<0.05】;干预组胶体和RBC输注单位分别为（503.5±120.4） mL和0.9（0.6,1.7）单位,显著低于对照组【分别为（743.4±243.7） mL和1.7（0.7,1.9）单位,P<0.05】;73例患者出现术后并发症,多因素分析显示红细胞压积和PPV指导为术后并发症发生的危险因素（P<0.05）。结论 运用PPV指导术中液体管理能改善肝内胆管结石行肝部分切除术患者的呼吸功能,减少输液量,缩短手术时间,减少术后并发症。

PPV-guided fluid therapy in patients with hepatolithiasis underwent partial hepatectomy

Objective To investigate the efficacy of pulse pressure variation （PPV）-guided fluid therapy in patients with hepatolithiasis underwent partial hepatectomy（PH）. Methods A total of 260 patients with hepatolithiasis were enrolled in our hospital between March 2008 and March 2017,and all patients underwent laparoscopic partial hepatectomy. During operation,PPV-guided fluid therapy was done in 134 patients. Logistic regression analysis was applied to evaluate the risk factors affecting post-operational complications. Results The intraoperative tidal volume in control was （7.5±1.3） mL/kg,much lower than（8.2±1.4） mL/kg in PPV-guided group （P<0.05）;at the beginning of operation,mean arterial pressure （MAP） and hematocrit in the control were（97.3±15.4） mmHg and （28.6±5.8）%,significantly different compared to（87.4±17.2） mmHg and（34.2±7.4）% in PPV-guided group （P<0.05）;the duration of operation and central venous pressure （CVP） were （414.7±164.8） min and [9.4（5.4,10.2） mmHg,significantly different compared to （321.5±124.7） min and 10.3（6.3,12.8） mmHg in PPV-guided group （P<0.05）;24 hours after operation,the MAP and CVP in PPV-guided group were （81.8±13.5）mmHg and 8.3（6.2,10.1） mmHg,significantly lower than （85.6±14.8） mmHg and 11.4（8.1,14.7） mmHg, respectively, in the control（P<0.05）;the colloid and RBC transfusion in PPV-guided group were （503.5±120.4） mL and0.9（0.6,1.7） units,significantly less than （743.4±243.7） mL and 1.7（0.7,1.9） units in the control （P<0.05）;the post-operational complications occurred in 73 cases,and multivariate analysis showed that the hematocrit and PPV guidance were the independent risk factors affecting the post-operational complication occurrence. Conclusion PPV-guided fluid therapy might improve respiratory function of patients undergoing laparoscopic partial hepatectomy for intrahepatic bile duct stones.