摘要
目的评价在控制性低中心静脉压技术下行腹腔镜下肝切除术时应用经食道超声心动图监测心脏气栓的重要性。方法拟定择期腹腔镜下右肝部分切除术的患者40例,性别不限,年龄38~73岁,体重40~90 kg,ASA分级Ⅱ或Ⅲ级。采用简单随机数字表法,将其分为2组(n=20)对照组和控制性低中心静脉压组。控制性低中心静脉压组把中心静脉压控制在0~5mmHg的较低范围内,对照组把中心静脉压维持在正常范围。两组患者均应用经食道超声心动图监测心脏是否出现气泡,并记录出现气泡的维持时间,若出现气泡则提醒建议术者行夹闭血管漏口等相关处理。记录两组患者术前术后的平均动脉压、心率、术中出血量、术后是否送ICU治疗、术后神经并发症情况。结果与低中心静脉压组比较,对照组患者心腔内气泡发生以及术中出血量增高(P<0.05)。两组患者术后的平均动脉压、心率、术后进入ICU治疗的发生率及神经并发症情况的差异无统计学意义(P>0.05)。结论控制性低中心静脉压技术下行腹腔镜下右肝部分切除术可以减少术中的出血量。同时,应用经食道超声心动图监测心脏内的气泡,可以有效保证患者免受或减少气栓的威胁,保证患者安全。
Objective To evaluate the importance of transesophageal echocardiography(TEE)monitoring during laparoscopic liver resection under low central venous pressure.Methods Forty patients scheduled for elective laparoscopic hectomy,aged38-73yr,weighing40-90kg,of ASA physical statusⅡorⅢ,were divided into two groups(n=20,each group),control group and low central venous pressure group(LCVP).The patients of LCVP were performed laparoscopic liver resection with central venous pressure below5mmHg(0-5mmHg),while those of control with a normal CVP.Transesophageal echocardiography(TEE)was used to monitor the bubbles in the heart in both two groups.Clinical parameters were recorded included mean arterial pressure and heart rate before and after surgery,the amount of bleeding,whether entered ICU after surgery and whether had neuropathic complications.Results Compared with LCVP group,the incidence of air embolism and the amount of intraoperative bleeding were increased in control group.No significant change was found in mean arterial pressure and heart rate after surgery,neuropathic complications and the admission rate to ICU between two groups.Conclusion Low central venous pressure reduced bleeding during laparoscopic liver resection.The application of transesophageal echocardiography to monitor the bubbles in the heart avoided the risk of air embolism.
作者
邓靖单
张岳农
曾志文
林跃华
罗荣
张伟强
DENG Jingdan;ZHANG Yuenong;ZENG Zhiwen;LIN Yuehua;LUO Rong;ZHANG Weiqiang(Department of Anesthesiology,Meizhou People’s Hospital,Meizhou,Guangdong 514011,China)
出处
《岭南现代临床外科》
2017年第5期528-530,534,共4页
Lingnan Modern Clinics in Surgery
关键词
控制性低中心静脉压
经食道超声心动图
腹腔镜下肝切除术
气栓
脑损伤
low central venous pressure
transesophageal echocardiography (TEE)
laparoscopic hepatectomy
aeroembolism
brain injury
