中国现代医学杂志2008，Vol.18Issue(5)：518-522,527,6.
低中心静脉压麻醉并急性高容血液稀释序贯用于肝叶切除围术期血液保护
Effect of sequent use of low central venous pressure anesthesia and acute hypervolemic haemodilution on perioperative blood conservation in hepatic resections
摘要
Abstract
[Objective]To observe the effect of sequent use of low central venous pressure anesthesia(LCVPA)and acute hypervolemic haemodihtion(AHHD)on perioperative blood conservation in hepatic resections.[Methods]60 primary malignant hepatoma patients were randomly divided into group Ⅰ,Ⅱ,Ⅲ,in group Ⅰ common fluid therapy was used,in group Ⅱ AHHD was used after intubation,and in group Ⅲ the patients were be limited to infuse fluids(1ml/kg/hr)until the time after parenchymal transection and let the CVP at 1-5 cm H2O,maintained mean arterial pressure(MAP)≥70 mmHg with lower dosage noradrenaline,then AHHD was be used until the CVP and MAP recovered.The MAP,CVP,BS,Hb,Hct,WBC,PT,APTT,Fib,GPT,BUN,Cr at every time point,infused fluids and urinary output at every periods,intraoperative blood loss,allogeneic Red Cell Concentrate(RCC)transfusion,the cases of allogeneic non-transfused and the complications were be observed.[Results]In group Ⅲ,from pre-incision to the time after parenchymal transection the MAP,CVP were lower and recoverd at the end of operation,from pre-incision to the end of operation the Hb,HCT were higher,from the time after parenchymal transection to the end of operation the WBC was lower and perioperative BS,GPT were stable,infused fluids and urinary output were lower before parenchymal transection,but there was no significant diffefence from preopemtion to the end of operation between three groups.The intraoperative blood loss of group Ⅰ,Ⅱ,Ⅲ was(905.4±557.7)ml,(943.2+479.1)ml,(490.3+311.1)ml respectively(Ⅰ VS Ⅲ,Ⅱ VS Ⅲ,P＜0.01);the intraoperative allogeneic Red Cell Concentrate (RCC)transfusion of group Ⅰ,Ⅱ,Ⅲ was(4.1+2.2)u,(3.8+2.1)u,(1.2+1.5)u,respectively(Ⅰ VS Ⅲ,Ⅱ VS Ⅲ,P＜0.01);The cases of allogeneic non-transfused of group Ⅰ,Ⅱ,Ⅲ were 1(5%),1(5%),11(55%)(Ⅰ VS Ⅲ,ⅡVS Ⅲ,P＜0.01);There were not complications in all patients.[Conclusions]The sequent use of low central venous pressure anesthesia and acute hypervolemic haemodilution in hepatic resections can decrease blood loss and allogeneic RCC transfusion,and have stabler BS and liver functions.关键词
低中心静脉压/血液稀释/肝叶切除/血液保护Key words
low central venous pressure/haemodilution/hepatic resection/blood conservation分类
医药卫生引用本文复制引用
杨金凤,高星杨,董长生,王明德,吴飞跃,常业恬..低中心静脉压麻醉并急性高容血液稀释序贯用于肝叶切除围术期血液保护[J].中国现代医学杂志,2008,18(5):518-522,527,6.基金项目
This report is the assistant project of Hunan province science committee,number:99SSYZ002-1,the title is clinical research of hepatic resection under low central venous pressure. （）
