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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (06) : 538 -542. doi: 10.3877/cma.j.issn.2095-3232.2020.06.009

所属专题： 文献；

临床研究

腹腔镜肝癌切除术中CVP与出血量关系及其影响因素
李文轩1, 潘扬勋1, 侯嘉杰1, 侯靖禹1, 陆霄云2, 赖仁纯2, 王小辉1, 王骏成1, 徐立1, 张耀军1, 陈敏山1, 周仲国1,†()   
  1. 1. 510060　广州，华南肿瘤学国家重点实验室　肿瘤医学协同创新中心　中山大学肿瘤防治中心肝脏外科
    2. 510060　广州，华南肿瘤学国家重点实验室　肿瘤医学协同创新中心　中山大学肿瘤防治中心麻醉科
  • 收稿日期:2020-07-06 出版日期:2020-12-10
  • 通信作者: 周仲国
  • 基金资助:
    白求恩公益基金(HZB20181119); 中山大学肿瘤防治中心医师科学家基金(16zxqk04)

Relationship between central venous pressure and blood loss in laparoscopic hepatectomy for liver cancer and its influencing factors

Wenxuan Li1, Yangxun Pan1, Jiajie Hou1, Jingyu Hou1, Xiaoyun Lu2, Renchun Lai2, Xiaohui Wang1, Juncheng Wang1, Li Xu1, Yaojun Zhang1, Minshan Chen1, Zhongguo Zhou1,†()   

  1. 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
    2. Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
  • Received:2020-07-06 Published:2020-12-10
  • Corresponding author: Zhongguo Zhou
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引用本文：

李文轩, 潘扬勋, 侯嘉杰, 侯靖禹, 陆霄云, 赖仁纯, 王小辉, 王骏成, 徐立, 张耀军, 陈敏山, 周仲国. 腹腔镜肝癌切除术中CVP与出血量关系及其影响因素[J/OL]. 中华肝脏外科手术学电子杂志, 2020, 09(06): 538-542.

Wenxuan Li, Yangxun Pan, Jiajie Hou, Jingyu Hou, Xiaoyun Lu, Renchun Lai, Xiaohui Wang, Juncheng Wang, Li Xu, Yaojun Zhang, Minshan Chen, Zhongguo Zhou. Relationship between central venous pressure and blood loss in laparoscopic hepatectomy for liver cancer and its influencing factors[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(06): 538-542.

目的

探讨腹腔镜肝癌切除术中中心静脉压（CVP）与出血量的关系及其影响因素。

方法

回顾性分析2017年9月至2018年9月在中山大学肿瘤防治中心行腹腔镜肝癌切除术的137例患者临床资料。其中男116例，女21例；年龄23～79岁，中位年龄55岁。患者均签署知情同意书，符合医学伦理学规定。根据术中出血量将患者分为术中出血量≤200 ml组和术中出血量>200 ml组。两组术中CVP比较采用t检验，CVP相关影响因素分析采用多重线性回归分析。

结果

术中出血量>200 ml组断肝前CVP、断肝期间CVP、断肝前后CVP差值（ΔCVP）分别为（12±5）、（7±4）、（5±4）cmH2O，明显高于术中出血量≤200 ml组的（8±6）、（5±4）、（3±4）cmH2O（t=3.823，2.289，2.680；P<0.05）。回归分析显示，硝酸甘油维持剂量与断肝前CVP的关系最大（t=4.496，P<0.05），术中出血量、硝酸甘油维持剂量与断肝期间CVP的关系最大（t=3.008，2.355；P<0.05），气道峰压、硝酸甘油维持剂量与ΔCVP的关系最大（t=3.017，2.664；P<0.05）。

结论

腹腔镜肝切除术术中出血量与CVP相关，通过调节硝酸甘油维持剂量、气道峰压可以维持腹腔镜肝切除术中低CVP水平，有助于减少术中出血，提高手术安全性。

关键词: 肝肿瘤, 腹腔镜, 肝切除术, 中心静脉压, 失血, 手术
Objective

To explore the relationship between central venous pressure (CVP) and blood loss in laparoscopic hepatectomy for liver cancer and to identify its influencing factors.

Methods

Clinical data of 137 patients who underwent laparoscopic hepatectomy in Sun Yat-sen University Cancer Center from September 2017 to September 2018 were retrospectively analyzed. Among them, 116 patients were male and 21 female, aged from 23 to 79 years, with a median age of 55 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to intraoperative blood loss, all patients were divided into the ≤200 ml and >200 ml groups. Intraoperative CVP was statistically compared between two groups by using t test. The influencing factors of CVP were identified by multiple linear regression analysis.

Results

In the intraoperative blood loss > 200 ml group, CVP before liver resection, CVP during liver resection, and ΔCVP (the difference between CVP before and after liver resection) were (12±5), (7±4) and (5±4) cmH2O, significantly higher than (8±6), (5±4) and (3±4) cmH2O in the intraoperative blood loss ≤200 mlgroup (t=3.823, 2.289, 2.680; P<0.05). Regression analysis showed that nitroglycerin maintenance dose was the most significantly correlated with the CVP before liver resection (t=4.496, P<0.05). Intraoperative blood loss, nitroglycerin maintenance dose were the most significantly correlated with the CVP during liver resection (t=3.008, 2.355; P<0.05). The peak airway pressure and nitroglycerin maintenance dose were the most significantly correlated with ΔCVP (t=3.017, 2.664; P<0.05).

Conclusions

The blood loss during laparoscopic hepatectomy is correlated with CVP. The low CVP level can be maintained by adjusting nitroglycerin maintenance dose and airway pressure during laparoscopic hepatectomy, which contributes to reducing intraoperative bleeding and improving surgical safety.

Key words: Liver neoplasms, Laparoscopes, Hepatectomy, Central venous pressure, Blood loss, surgical
表1 137例腹腔镜肝癌切除术不同术中出血量组患者一般资料比较
组别 例数 性别（男/女） 年龄[岁，M(QR)] BMI[kg/m2, M(QR)] ALT(U/L，±s) ALB(g/L，±s) TB(μmol/L，±s) Scr(μmol/L，±s)
术中出血量≤200 ml组 76 63/13 55(17) 23(5) 35±27 44±3 14±6 75±16
术中出血量>200 ml组 61 53/8 55(13) 23(4) 38±28 44±3 12±4 74±16
统计值   χ2=0.415 Z=0.780 Z=1.057 t=-0.569 t=0.210 t=1.542 t=0.253
P值   0.519 0.435 0.291 0.570 0.834 0.125 0.800
表2 137例腹腔镜肝癌切除术不同术中出血量组患者CVP影响因素回归分析
变量 断肝期前CVP
偏回归系数 标准误 标准偏回归系数 t值 P值
常数项 8.550 0.534   16.007 <0.001
硝酸甘油维持剂量 5.811 1.292 0.361 4.496 <0.001
变量 断肝期间CVP
偏回归系数 标准误 标准偏回归系数 t值 P值
常数项 4.263 0.473   9.011 <0.001
术中出血量 0.003 0.001 0.247 3.008 0.003
硝酸甘油维持剂量 2.175 0.923 0.193 2.356 0.020
变量 ΔCVP
偏回归系数 标准误 标准偏回归系数 t值 P值
常数项 -2.654 2.059   -1.289 0.200
气道峰压 0.332 0.110 0.248 3.017 0.003
硝酸甘油维持剂量 2.744 1.030 0.219 2.664 0.009
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