控制性低中心静脉压联合急性高容性血液稀释在右半肝切除术中的应用

目的观察控制性低中心静脉压(CLCVP)联合急性高容性血液稀释技术(AHH)对右半肝切除术中出血量的控制及术后肝、肾功能的影响。方法 60例行右半肝切除术的患者随机分为三组(n=20):肝门阻断组(A组),CLCVP组(B组)和CLCVP联合AHH组(C组),分别在不同时点记录各组患者的生命体征、术中液体输入量、出血量、红细胞悬液输入量、血浆输入量和尿量等指标。所有患者在术后1d、3d和7d取中心静脉血6m L,检测肝功能和肾功能。结果与A组患者相比,B组和C组术中出血量明显减少,差异有统计学意义(P<0.05);C组患者输入红细胞悬液量和血浆量也明显少于A组和B组(P<0.05);与A组和B组相比,C组患者的谷丙转氨酶(ALT)术后恢复的更快,尿素氮(BUN)和肌酐(Cr)波动更小。结论 CLCVP联合AHH能明显减少术中出血量和输血量,且有更好的肝、肾保护作用。

Application of Controlled Low Central Venous Pressure Combined with Acute Hypervolemic Hemodilution in Right Hemihepatectomy

Objective To observe the effect of controlled low central venous pressure( CLCVP) combined with acute hypervolemic hemodilution( AHH) on the amount of hemorrhage in right hemihepatectomy and the effect of postoperative liver and renal function.Methods 60 patients undergoing right hemihepatectomy were randomly divided into three groups( n = 20) : hippocampal occlusion group( group A),CLCVP group( group B) and CLCVP combined with AHH group( group C).The vital signs,intraoperative fluid input,blood loss,erythrocyte suspension input,plasma input and urine output were recorded at different time. For all patients,6 m L of central venous blood were collected at 1 day,3 days and 7 days after operation to test liver function and renal function.Results Compared with group A,the blood loss of group B and group C was significantly lower( P<0. 05); The transfusion amount of erythrocyte suspension and plasma in group C was significantly lower than that in group A and group B; Compared with group A and group B,the alanine aminotransferase( ALT) of group C recovered faster,and urea nitrogen( BUN) and creatinine( Cr)fluctuations were smaller.Conclusion CLCVP combined with AHH can significantly reduce intraoperative blood loss and blood transfusion,and can protect liver and kidney function.