中心静脉压的作用及血管控制类型对大肝切除术中失血的影响

The role of central venous pressure and type of vascular control in blood loss during major liver resections.

作者信息

Smyrniotis Vassilios, Kostopanagiotou Georgia, Theodoraki Kassiani, Tsantoulas Dimitrios, Contis John C

机构信息

Department of Surgery, University of Athens School of Medicine, Athens, Greece.

出版信息

Am J Surg. 2004 Mar;187(3):398-402. doi: 10.1016/j.amjsurg.2003.12.001.

DOI:10.1016/j.amjsurg.2003.12.001

PMID:15006570

Abstract

BACKGROUND

Blood loss during liver resection constitutes the primary determinant of the postoperative outcome. Various techniques of vascular control and maintenance of a low central vein pressure (CVP) have been used in order to prevent intraoperative blood loss and postoperative complications. Our study aims at assessing the effects of different levels of CVP in relation to type of vascular control on perioperative blood loss and patient outcome.

METHODS

The records of 102 consecutive patients who underwent a major hepatectomy were retrospectively analyzed. Forty-two patients were operated on with a CVP of 6 mm Hg or more and 60 patients had a CVP of 5 mm Hg or less. The Pringle maneuver was used in 45 patients and selective hepatic vascular exclusion (SHVE) in 57 patients. Blood loss, complications, and mortality were analyzed comparing the two CVP groups in relation to type of vascular control.

RESULTS

The Pringle maneuver is associated with more blood loss when CVP is 6 mm Hg or more compared with CVP 5 mm Hg or less (1,250 mL [250 to 2,850] versus 780 mL [150 to 3,100]; P <0.05). Conversely, blood loss during SHVE is independent of the CVP levels. A significant difference in blood loss between the Pringle maneuver and SHVE was observed, only when CVP was 6 mm Hg or more (1,250 mL [250 to 2,850] versus 680 mL [150 to 1,260]; P <0.05). Hospital stay was also significantly longer in patients operated on with CVP 6 mm Hg or more (15 days [4 to 38] than in patients with CVP 5 mm Hg or less (10 days [4 to 32]; P <0.05).

CONCLUSIONS

Elevated CVP during major liver resections results in greater blood loss and a longer hospital stay. The Pringle maneuver with CVP 5 mm Hg or less is associated with blood loss not significantly different from that with SHVE. The latter, though, has been shown not to be affected by CVP levels and should be used whenever CVP remains high despite adequate anesthetic management.

摘要

背景

肝切除术中的失血是术后结果的主要决定因素。为防止术中失血和术后并发症，已采用了各种血管控制技术和维持低中心静脉压（CVP）的方法。我们的研究旨在评估不同CVP水平与血管控制类型对围手术期失血和患者预后的影响。

方法

回顾性分析102例连续接受大肝切除术患者的记录。42例患者手术时CVP为6mmHg或更高，60例患者CVP为5mmHg或更低。45例患者采用了Pringle手法，57例患者采用了选择性肝血管阻断（SHVE）。比较两个CVP组在血管控制类型方面的失血、并发症和死亡率。

结果

与CVP为5mmHg或更低相比，当CVP为6mmHg或更高时，Pringle手法导致的失血量更多（1250mL[250至2850]对780mL[150至3100]；P<0.05）。相反，SHVE期间的失血与CVP水平无关。仅当CVP为6mmHg或更高时，观察到Pringle手法和SHVE之间的失血量有显著差异（1250mL[250至2850]对680mL[150至1260]；P<0.05）。CVP为6mmHg或更高的手术患者的住院时间也明显长于CVP为5mmHg或更低的患者（15天[4至38]对10天[4至32]；P<0.05）。