控制性低中心静脉压技术在腹腔镜肝切除术中的临床应用

目的 探讨控制性低中心静脉压技术（CLCVP）在腹腔镜肝切除术中的可行性及安全性。方法 选取我院在2016年1月至2017年5月收治的行择期腹腔镜肝切除术患者50例，分为控制性低中心静脉压（CLCVP）组和常规中心静脉压（NCVP）组，各25例，CLCVP组术中应用控制性低中心静脉压技术，维持CVP在3~5cmH2O，保持SAP≥90mmHg，NCVP组采用常规腹腔镜手术，维持CVP在6~12cmH2O；观察两组患者切肝时间、术中出血量、输血例数、平均输血量、血流动力学指标、术后肝肾功能、有无气体栓塞发生。结果 手术指标：CLCVP组切肝时间、术中出血量、平均输血量明显低于NCVP组，差异具有统计学意义（P<0.05）；两组患者术中、术后均无具有临床意义的气体栓塞发生。肝肾功能：两组患者术后第1dALT、AST、TB水平明显升高，之后逐渐下降，至术后第5d时接近术前水平；相同时间点CLCVP组ALT、AST、TB水平低于NCVP组，差异具有统计学意义（P<0.05）；血清白蛋白（ALB）水平术后第1d明显下降，之后轻度升高，相同时间点的组间比较差异无统计学意义（P>0.05）；两组患者BUN、Scr水平术前、术后相同时间点比较差异无统计学意义（P>0.05），BUN、Scr变化趋势为术后第1d轻度升高，之后逐渐下降。血流动力学指标：术中不同时间点两组患者MAP、HR比较差异无统计学意义（P>0.05）；CLCVP组脑电双频指数（BIS）在切肝开始5min和切肝结束时与NCVP组比较明显下降，差异具有统计学意义（P<0.05）。结论 控制性低中心静脉压技术（CLCVP）在腹腔镜肝切除术中能够减少出血量、缩短切肝时间，促进术后肝功能恢复，具有较高的应用价值。

Clinical application of controlled low central venous pressure in laparoscopic hepatectomy

Objective To investigate the feasibility and safety of controlled low central venous pressure (CLCVP) in laparoscopic hepatectomy. Methods Fifty patients underwent elective laparoscopic hepatectomy from January 2016 to May 2017 were attributed to control group (CLCVP) group and conventional central venous pressure (NCVP) group. The patients in CLCVP group were treated with controlled low central venous pressure technique to maintain CVP in 3-5 cmH2O, and keep SAP≥90 mmHg. Those in NCVP group underwent conventional laparoscopic surgery and maintained CVP in 6-12 cmH2O. The cut liver time, intraoperative Bleeding volume, blood transfusion, mean blood transfusion, hemodynamic parameters, postoperative liver and kidney function, with or without gas embolism were observe, recorded and analyzed in two group of patients. Results The cut liver time, intraoperative blood loss, the average blood transfusion in CLCVP group were significantly lower than that in NCVP group, the differences was statistically significant. Serum levels of ALT, AST and TB were significantly increased in the two groups after 1 day, and then gradually decreased, and reached the preoperative level at the 5th day after operation. The levels of ALT, AST and TB in CLCVP group were lower than those in NCVP group at the same time point, the difference was statistically significant. Serum albumin (ALB) levels were significantly decreased on the first day after surgery in two groups, and there were no significant differences between the same time points. There were no significant differences in BUN and Scr levels between the two groups before and after the same time. There was no significant difference in MAP and HR between the two groups at different time points. The white blood cell count of CLCVP group was significantly lower than that of NCVP group at 5 min and at the end of cut liver, and the difference was statistically significant. Conclusion CLCVP can reduce the amount of bleeding, reduce the time of cutting liver and promote the recovery of liver function after laparoscopic hepatectomy.