摘要
目的探讨肝脏切除手术中不同降低中心静脉压(CVP)的方法及策略。方法通过文献检索,对目前低CVP的定义、实现方法、相关并发症及对预后的影响及其在肝脏手术中最合适CVP的相关研究进行了回顾总结。结果低CVP在肝脏切除术中已经得到了广泛应用,其减少术中出血、降低围术期输血的作用已经得到了肯定。目前实现低CVP的方法众多,包括麻醉药物、血管活性药物、限制性液体输注、肝下下腔静脉钳夹、低通气量等,没有围术期最佳策略的定论。目前仍缺乏其对患者远期预后影响的研究。术中维持CVP为2.1~3 mm Hg (1 mm Hg=0.133 kPa)可能较为适宜,一旦肝脏实质横断等主要操作结束,应立即恢复患者的血流动力学状态。结论肝脏切除手术中低CVP的应用可以减少围术期出血及输血,但其对患者的远期预后不得而知,在特定人群应用需谨慎。
Objective To investigate various methods and strategies of lowering central venous pressure(CVP) during hepatectomy. Method Through literature review, the definition, implementation, related complications, and prognosis of low CVP were reviewed and summarized and the most appropriate CVP in the liver surgery was also summarized. Results The low CVP had been widely applied in the different clinical settings. Its effect of reducing hemorrhage and transfusion had been recognized. There were many techniques to intraoperatively reduce the CVP such as the volatile anesthetics, vasoactive agents, fluid restrictive strategy, inferior vena cava clamping, low tidal volume, etc. However, there was no consensus on the best strategy to reduce the CVP and there were no studies focusing on the prognosis of patients underwent the low CVP hepatectomy. Maintaining the CVP between 2.1-3 mm Hg(1 mm Hg=0.133 kPa) intraoperatively might be appropriate, once the section had been made normal hemodynamic state of the patient should be restored immediately. Conclusions Application of low CVP could reduce blood loss and transfusion in hepatectomy. Prognosis of patients receiving low CVP is not clear. Application of low CVP in specific population should be cautious.
作者
许钊
玉红
梁鹏
XU Zhao;YU Hong;LIANG Peng(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2020年第1期107-112,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
国家自然科学基金资助项目(项目编号：81600918)
关键词
肝脏切除术
低中心静脉压
预后
hepatectomy
low ventral venous pressure
prognosis
