低容量性自体储血在肝癌切除患者术中的临床观察

Clinical Observation of Hypovolemic Phlebotomy in Patients with Hepatocellular Carcinoma Resection

关键词:  肝癌  低容量性自体储血  肝切除术  出血量  输血  安全可靠性

Key words:  hepatic carcinoma  hypovolemic phlebotomy  hepatectomy  hemorrhage volume  transfusion  reliability

摘要:

本研究拟探讨在肝癌肝部分切除术中应用低容量性自体储血对失血和输血的影响及其安全可靠性。选取择期行开腹肝癌肝脏部分切除术的患者80例，随机分为对照组（C组）和观察组（H组）：H组在开腹后切除肝实质前缓慢采集占体重0.7%的全血，同时限制输液维持采血后的中心静脉压（Central Venous Pressure，CVP）在目标范围内直至肝实质切除完毕，再回输自体血；C组未实行采血。记录术中手术和麻醉情况、术后重要脏器功能、术后并发症以及住院时间等情况。结果显示，H组患者低容量性自体储血的采血量平均数是450 mL，低容量性自体储血后CVP平均降低2.27 cmH₂O，H组的出血量比C组低（P<0.05）。两组术中心率（Heart Rate，HR）、平均动脉压（Mean Arterial Pressure，MAP）、总住院时间、术后住院时间和术后并发症均无明显差异（P>0.05）。所有患者在院内均未出现严重并发症。在肝癌肝脏部分切除术中实行低容量性自体储血能有效降低CVP，减少出血量和异体血的输注，未出现明显并发症，安全可靠性良好。

Abstract:

This study intends to investigate the effect of Hypovolemic Phlebotomy (HP) on blood loss and blood transfusion in partial hepatectomy for liver cancer and its safety and reliability. 80 patients with liver cancer undergoing partial hepatectomy were randomly divided into the control group (group C) and observation group (group H). The patients in group H were slowly collected 0.7% of the weight of whole blood before liver parenchymal resection. Meanwhile the infusion was limited to maintain the Central Venous Pressure (CVP) within the target range until liver parenchymal resection was completed.The autologous blood transfusion was performed after liver parenchymal resection. Blood sampling was not performed in group C.The intra-operative surgery and anesthesia, the function of important organ after operation, postoperative complications and hospitalization time were recorded. The results showed that the average volume of HP in group H was 450 mL, and the average CVP decreased by 2.27 cmH₂O after hypovolemic phlebotomy. The amount of bleeding in group H was lower than that in group C (P<0.05).There were no significant differences in intra-operative Heart Rate (HR), Mean Arterial Pressure (MAP), total hospitalization time, postoperative hospitalization time and postoperative complications between the two groups (P>0.05). No serious complications occurred in all patients in hospital. In partial hepatectomy of hepatocellular carcinoma, HP can reduce CVP, and then reduce blood loss and allogenic blood transfusion, without obvious complications. HP has good safety and reliability.