摘要
目的探讨控制性低中心静脉压(controlled low central venous pressure,CLCVP)辅助区域麻醉介导少阿片化全身麻醉在腹腔镜左半肝切除术中的麻醉效果及安全性。方法回顾性分析2018年1月~2022年12月择期腹腔镜左半肝切除术治疗肝癌或肝血管瘤40例的临床资料,其中20例采用CLCVP辅助全身麻醉(对照组),20例CLCVP辅助区域麻醉介导少阿片化全身麻醉(观察组),比较2组术中平均动脉压、心率、手术时间、出血量以及麻醉不良事件。结果2组均顺利完成手术。观察组在输注硝酸甘油20 min、肝叶切除后平均动脉压降低及建立气腹、输注硝酸甘油20 min时心率增加较对照组更不明显(P<0.05),且观察组手术时间短[(4.30±0.73)h vs.(6.10±1.02)h,t=-6.406,P=0.000],术中出血少[300(100~500)ml vs.700(300~1600)ml,Z=-5.106,P=0.000],麻醉不良事件如苏醒延迟(0例vs.10例,P=0.000)、呼吸遗忘(0例vs.15例,P=0.000)、恶心呕吐(3例vs.12例,χ^(2)=8.640,P=0.003)较对照组少,2组谵妄发生率差异无显著性(P>0.05)。结论CLCVP辅助区域麻醉介导少阿片化全身麻醉可以安全用于腹腔镜左半肝切除术,能够满足手术需要,优于单纯的CLCVP辅助全身麻醉。
Objective To investigate the efficacy and safety of controlled low central venous pressure(CLCVP)assisted regional anesthesia mediated reducing opioids general anesthesia in laparoscopic left hemihepatectomy.Methods Clinical data of 40 cases of hepatoma or hepatic hemangioma treated by laparoscopic left hemihepatectomy from January 2018 to December 2022 were retrospectively analyzed,including 20 cases of CLCVP assisted general anesthesia(control group)and 20 cases of CLCVP assisted regional anesthesia mediated reducing opioids general anesthesia(observation group).The mean arterial pressure,heart rate,operation time,blood loss,and anesthesia adverse events were compared between the two groups.Results The operation was successfully completed in both groups.Compared with the control group,the mean arterial pressure decrease after 20 min of nitroglycerin infusion and after liver resection,and the heart rate increase after pneumoperitoneum establishment and after 20 min of nitroglycerin infusion were less obvious in observation group(P<0.05).The observation group had shorter operation time[(4.30±0.73)h vs.(6.10±1.02)h,t=-6.406.P=0.000],less intraoperative bleeding[300(100-500)ml vs.700(300-1600)ml,Z=-5.106,P=0.000],and less adverse anesthesia events such as delayed recovery(0 case vs.10 cases,P=0.000),respiratory amnesia(0 case vs.15 cases,P=0.000),nausea and vomiting(3 cases vs.12 cases,χ^(2)=8.640,P=0.003)than the control group.There was no significant difference in the incidence of delirium between the two groups(P>0.05).Conclusion CLCVP assisted regional anesthesia mediated reducing opioids general anesthesia can be safely used in laparoscopic left hemihepatectomy,which meets surgical needs and is better than CLCVP assisted general anesthesia alone.
作者
林晓东
郭雨
范春潮
刘冲
施小娇
张海铅
陈德兴
Lin Xiaodong;Guo Yu;Fan Chunchao(Anesthesiology Department,Jilin Province Qianwei Hospital,Changchun 130012,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2023年第9期657-661,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
控制性低中心静脉压
区域麻醉
少阿片化
左半肝切除
Controlled low central venous pressure
Regional anesthesia
Reducing opioid
Left hemihepatectomy
