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目的:探讨控制性低中心静脉压(low central venous pressure,LCVP)技术对肝细胞肝癌(hepatocellular carcinoma,HCC)切除术患者围手术期肝功能的影响。方法:30例按美国麻醉医师协会(ASA)麻醉分级Ⅰ或Ⅱ级的HCC根治术患者随机分为低中心静脉压组(L组)和对照组(N组),各15例。L组术中限制输液并静脉使用硝酸甘油和呋塞米,控制CVP在0~5mm H2O之间;N组常规输液,控制CVP在5~10 cm H2O。记录两组患者术前(T0)、手术结束时(T1)、术后第一天(T2)、第三天(T3)、第七天(T4)的血清谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(T.BIL)、直接胆红素(D.BIL)、间接胆红素(I.BIL)、总蛋白(TP)、白蛋白(ALB)、球蛋白(GLO)、前白蛋白(PA)的值。结果:两组AST、ALT较术前均增高,在T2时刻达到峰值,在T2时刻L组的ALT、AST明显高于N组,组间比较差异有统计学意义(P<0.05),T3、T4时间点肝功能逐渐恢复正常,组间比较差异无统计学意义(P>0.05)。而两组T.BIL、D.BIL、I.BIL、TP、ALB、GLO、PA手术前后各时点组间比较差异均无统计学意义(P>0.05)。结论:LCVP对HCC患者术后ALT、AST仅有短暂影响,术后一周可逐渐恢复,对术后肝脏合成和代谢功能影响不大。
Objective: To investigate the effect of controlled low central venous pressure (LCVP) on perioperative liver function in patients with hepatocellular carcinoma (HCC) resection. Methods Thirty patients with HCC undergoing anesthesia classification Ⅰ or Ⅱ under ASA were randomly divided into low central venous pressure group (group L) and control group (n = 15). In group L, intraoperative nitroglycerin and furosemide were intravenously infused intravenously and CVP was controlled between 0 and 5 mm H2O. Group N was given conventional infusion with CVP between 5 and 10 cm H2O. The levels of serum glutamate aminotransferase (ALT) in the two groups were recorded before surgery (T0), at the end of surgery (T1), on the first day (T2), on the third day (T3), on the seventh day , Aspartate aminotransferase (AST), total bilirubin, direct bilirubin, direct bilirubin, total protein, (ALB), globulin (GLO), prealbumin (PA) values. Results: The levels of AST and ALT in both groups were higher than those in preoperative and peaked at T2. The levels of ALT and AST in group L were significantly higher than those in group N at T2 (P <0.05) The liver function returned to normal gradually at T4 time point, with no significant difference between the two groups (P> 0.05). However, there was no significant difference between the two groups before and after operation (P> 0.05). CONCLUSION: LCVP has a short-term effect on the postoperative ALT and AST in patients with HCC. One week after operation, LCVP can recover gradually and has little effect on postoperative liver synthesis and metabolism.