文章摘要
去甲肾上腺素联合目标导向血流动力学管理对肝部分切除术患者术后恢复质量的影响
Effect of norepinephrine combined with goal-directed haemodynamic therapy on postoperative recovery quality in patients undergoing partial hepatectomy
  
DOI：10.12089/jca.2021.06.003
中文关键词: 去甲肾上腺素  目标导向血流动力学管理  肝部分切除术  术后肺部并发症  急性肾损伤  术中输液量
英文关键词: Norepinephrine  Goal-directed haemodynamic theray  Partial hepatectomy  Postoperative pulmonary complications  Acute kidney injury  Introperative infusion
基金项目:国家自然科学基金（81970542）；安徽省重点研究和开放计划（1804h08020267）
作者单位E-mail
彭晓慧 230032,合肥市,安徽医科大学第一附属医院麻醉科  
顾尔伟 230032,合肥市,安徽医科大学第一附属医院麻醉科 ay_guew_mz@163.com 
陈立建 230032,合肥市,安徽医科大学第一附属医院麻醉科  
张雷 230032,合肥市,安徽医科大学第一附属医院麻醉科  
王雷 230032,合肥市,安徽医科大学第一附属医院麻醉科  
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中文摘要:
      
目的 观察低中心静脉压（LCVP）管理联合目标导向血流动力学管理（GDHT）与去甲肾上腺素联合GDHT对肝部分切除术患者术中管理和术后恢复质量的影响。
方法 选择择期行肝部分切除术患者70例，男43例，女27例，年龄18～75岁，ASA Ⅱ或Ⅲ级，心功能NYHAⅠ或Ⅱ级，Child-Pugh评分A或B级。随机分为两组：LCVP管理联合GDHT组（LG组,n=33）和去甲肾上腺素联合GDHT组（NG组,n=3７）。两组均桡动脉连接Flotrac/Vigileo系统监测每搏量变异度（SVV）和心脏指数（CI），术中以MAP、SVV和CI为目标行GDHT。LG组在行肝部分切除时，调控CVP≤5 mmHg；NG组在麻醉诱导时开始泵注去甲肾上腺素0.04～0.20 μg·kg-1·min-1，直至手术结束。记录术中失血量、肝脏切除期间失血量、术中输液量；记录术后首次排气时间；记录术后急性肾损伤（AKI）、术后肺部并发症（PPCs）的发生情况以及术后住院时间。
结果 NG组术中输液量明显少于LG组（P<0.05），术后首次排气时间明显短于LG组（P<0.05）。两组术中失血量、肝脏切除期间失血量和术后住院时间差异无统计学意义。两组术后AKI、PPCs发生率差异无统计学意义。
结论 与LCVP管理联合GDHT比较，去甲肾上腺素联合GDHT可以安全用于肝部分切除术，可减少术中输液量，缩短患者术后首次排气时间。
英文摘要:
      
Objective To observe the effect of norepinephrine combined with goal-directed haemodynamic therapy and goal-directed haemodynamic therapy combined with low central venous pressure management on the intraoperative management and postoperative outcomes in patients undergoing partial hepatectomy.
Methods Seventy patients selected for partial hepatectomy surgery, 43 males and 27 females, aged 18-75 years, ASA physical status Ⅱ or Ⅲ, NYHA Ⅰ or Ⅱ, Child-Pugh A or B, were enrolled in this study and randomly assigned to two groups: goal-directed haemodynamic therapy combined with low central venous pressure management group (group LG, n = 33) and norepinephrine combined with goal-directed haemodynamic therapy group (group NG, n = 37). The FloTrac/Vigileo system was used to obtain the stroke volume variation (SVV) and cardiac index (CI) in the two groups. In group LG, CVP ≤ 5 mmHg was regulated during partial hepatectomy. In group NG, small dose (0.04-0.20 μg·kg-1·min-1) of norepinephrine was infused upon anesthesia induction to the end of the operation. Intraoperative blood loss, blood loss during liver resection, and intraoperative fluid infusion were recorded. Postoperative intestinal exhaust time, postoperative acute kidney injury (AKI), and postoperative pulmonary complications (PPCs) occurrence were recorded. The postoperative hospital stay was also recorded.
Results Compared with group LG, group NG had less intraoperative fluid infusion and shorter exhaust time. There was no statistically significant difference in the incidence of AKI and PPCs between the two groups. There was no statistically significant difference in blood loss during operation, blood loss during liver resection, and postoperative hospital stay between the two groups.
Conclusion Compared with goal-directed haemodynamic therapy combined with low central venous pressure management, norepinephrine combined with goal-directed haemodynamic therapy can reduce intraoperative fluid infusion and shorten postoperative exhaust time in patients undergoing partial hepatectomy.
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