摘要
目的比较下腔静脉塌陷率与中心静脉压指导下静脉输液在肝叶切除手术中的应用效果。方法选择本院行肝叶切除手术治疗的80例患者为纳入对象,根据患者所采用的静脉输液管理方式,将其均分为下腔静脉塌陷率组(下腔静脉组)及中心静脉压组。比较两组患者手术时间、术中出血量、尿量、总输液量、心率(HR)及平均动脉压(MAP)、肌酐(Cr)、谷草转氨酶(GOT)、谷丙转氨酶(GPT)、纤维蛋白原(FIB)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)及并发症发生情况。结果下腔静脉组术中出血量、尿量及总输液量均少于中心静脉压组(P<0.05)。在肝叶切除时、完成时及术毕时,下腔静脉组HR低于中心静脉压组,MAP高于中心静脉压组(P<0.05)。术后3天,两组患者GOT、GPT水平均升高,且下腔静脉组低于中心静脉压组(P<0.05)。术毕时,两组FIB水平均较术前下降,APTT、TT及PT均较术前延长,且下腔静脉组FIB水平高于中心静脉压组,APTT及PT均短于中心静脉压组(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论在肝叶切除手术中采用下腔静脉塌陷率指导静脉输液管理,较之传统中心静脉压监测方法,更有利于减少术中出血量,维持患者血流动力学稳定性,且对患者肝功能及凝血功能影响较小,安全性较好。
Aim To compare the application effects of inferior vena cava collapse rate and central venous pressure-guided intravenous fluid infusion in hepatic lobectomy.Methods Eighty patients undergoing hepatic lobectomy in our hospital were selected as the study subjects.Based on the intravenous fluid management method adopted,they were randomly divided into an inferior vena cava collapse rate group(inferior vena cava group)and a central venous pressure group.The operative time,intraoperative blood loss,urine output,total fluid infusion volume,heart rate(HR),mean arterial pressure(MAP),creatinine(Cr),glutamic-oxaloacetic transaminase(GOT),glutamic-pyruvic transaminase(GPT),fibrinogen(FIB),activated partial thromboplastin time(APTT),thrombin time(TT),prothrombin time(PT),and incidence of complications were compared between the two groups.Results The inferior vena cava collapse rate group had significantly less intraoperative blood loss,urine output,and total fluid infusion volume compared to the central venous pressure group(P<0.05).During hepatic lobe resection,at completion,and at the end of surgery,the heart rate(HR)in the inferior vena cava group was lower than that in the central venous pressure group,while the mean arterial pressure(MAP)was higher(P<0.05).Three days post-operation,GOT and GPT levels were increased in both groups,with the inferior vena cava group showing lower values than the central venous pressure group(P<0.05).At the end of surgery,fibrinogen(FIB)levels were decreased compared to preoperative values in both groups,while APTT,TT,and PT were prolonged.The inferior vena cava group exhibited higher FIB levels and shorter APTT and PT compared to the central venous pressure group(P<0.05).There was no statistically significant difference in complication rates between the two groups(P>0.05).Conclusion In hepatic lobectomy,compared to traditional central venous pressure monitoring methods,using the inferior vena cava collapse rate to guide intravenous infusion management is more conducive in reducing intraoperative bleeding,maintaining patient hemodynamic stability,and has less impact on patient hepatic function and coagulation function,with better safety.
作者
史劲飞
邵永斌
范印圭
孙登群
SHI Jinfei;SHAO Yongbin;FAN Yingui;SUN Dengqun(Department of Anesthesiology,Anhui Armed Police Corps Hospital,Hefei 230001,Anhui,China;Department of Ultrasound,Anhui Armed Police Corps Hospital,Hefei 230001,Anhui,China;Department of General Surgery,Anhui Armed Police Corps Hospital,Hefei 230001,Anhui,China)
出处
《中南医学科学杂志》
2025年第4期716-719,738,共5页
Medical Science Journal of Central South China
基金
武警部队科技创新团队自主科研项目(ZZKY20242101)。
关键词
下腔静脉塌陷率
中心静脉压
输液管理
肝叶切除术
inferior vena cava collapse rate
central venous pressure
fluid management
hepatic lobectomy
