摘要
目的探究控制性低中心静脉压(CLCVP)对老年患者腹腔镜肝叶切除术脑血管事件的影响。方法选取60例择期行全麻下腹腔镜肝叶切除术的老年患者,随机分为控制性低中心静脉压组(L组)和对照组(C组)。L组患者在肝脏实质完全离断前将CVP控制在0~5 cmH 2O,同时维持平均动脉压(MAP)>70mmHg(9.33 kPa,1 kPa=7.5 mmHg),肝叶切除和止血完成后,以晶胶体补充所缺失容量,保持正常血流动力学稳定;C组CVP维持在6~12 cmH 2O。两组均根据需要使用血管活性药物维持血流动力学稳定,术前和手术结束时检测凝血功能及血小板计数,记录术中患者输液量、术中出血量、肝门阻断时间、手术时间、尿量,术后7 d脑血管事件的发生情况。结果L组术中输液量、术中出血量、尿量、手术时间、肝门阻断时间均少于C组,差异均具有统计学意义(P<0.05);L组术前、术后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)比较差异均无统计学意义(P>0.05);L组血小板计数及纤维蛋白原(FIB)明显高于C组,差异均具有统计学意义(P<0.05);L组术后7 d脑血管疾病发生情况高于C组,差异具有统计学意义(P<0.05)。结论CLCVP虽然降低了老年腹腔镜肝叶切除的术中出血量,缩短了肝门阻断时间及手术时间,但增加了术后脑血管事件的风险,应充分评估,合理应用。
Objective To investigate the effect of controlled low central venous pressure(CLCVP)on cerebrovascular events in older patients undergoing laparoscopic hepatolobectomy.Methods 60 older patients undergoing elective laparoscopic hepatic lobectomy were randomly divided into low central venous pressure group(group L)and control group(group C).In group L,CVP was controlled at 0-5 cmH 2O and mean arterial pressure(MAP)was maintained at>70 mmHg(9.33 kPa)before complete disconnection of liver parenchyma.After lobe resection and hemostasis,the missing volume was supplemented with crystal colloid to maintain normal hemodynamics.In grouo C,CVP was controlled at 6~12 cmH 2O.The vasoactive drugs were used as needed to maintain hemodynamic stability in both groups.The coagulative function and platelet were tested before and after surgery.The amount of intraoperative infusion and blood loss,duration of hepatic inflow occlusion,operation time,urine volume,and the occurrence of cerebrovascular events on day 7 after surgery were recorded.Results The intraoperative infusion volume,intraoperative blood loss,urine volume,operation time and hepatic portal blocking time in group L were less than those in group C(P<0.05).In group L,there were no significant differences in prothrombin time(PT)and activated partial thromboplastin time(APTT)before and after surgery(P>0.05).Platelet and fibrinogen(FIB)in group L were significantly higher than those in group C(P<0.05).The incidence of cerebrovascular diseases on day 7 after surgery in group L was higher than that in group C(P<0.05).Conclusion Although CLCVP may reduce intraoperative blood loss,shorten the duration of hepatic portal occlusion and operation time during laparoscopic partial hepatectomy in the elderly,it may increase the risk of postoperative cerebrovascular events.
作者
赵博
李乐
杨晨
高娜
卢锡华
Zhao Bo;Li Le;Yang Chen;Gao Na;Lu Xihua(Department of Anesthesiology,the Affiliated Tumor Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou 450000,China)
出处
《国际老年医学杂志》
2020年第3期154-156,共3页
International Journal of Geriatrics
基金
河南省科技攻关计划省部共建项目(SBGJ2018086)。
关键词
控制性低中心静脉压
腹腔镜
肝叶切除术
脑血管事件
老年
Controlled low center venous pressure
Laparoscope
Hepatolobectomy
Cerebrovascular events
Elderly
