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目的 研究经腹全肝血流阻断肝切除术围术期的酸碱状态与调控。方法 选择 10例择期肝脏切除患者 ,在肝血流阻断前补液以林格液与血定安按 3∶1的比例充分扩容 ,并在围麻醉期使用多巴胺 3～ 5 μg·kg-1·min-1,分别于切皮、进腹探查时、肝血流阻断前、阻断后 5min、阻断后 10min、肝血流开放后 5min及术毕各时点采取动脉血作血气分析。结果 碱剩余 (BE)在肝血流开放后 5min与阻断前相比较有所下降 (P <0 0 5 ) ,而 pH、实际碳酸氢根浓度 (AB)、二氧化碳结合力 (TCO2 )、标准碳酸氢根浓度 (SB)、血氧饱和度 (SaO2 )等在阻断前后变化不大。结论 经腹全肝血流阻断肝切除术中只要维持血流动力学相对稳定与充分的内脏灌注 ,无须常规补充碱性药物 ,有利于患者术后恢复。
Objective To study the perioperative acid-base status and regulation of transabdominal total hepatic blood flow blocking hepatectomy. Methods Ten patients undergoing elective hepatectomy were enrolled in this study. The Ringer’s solution was added to the blood solution at a ratio of 3: 1, and the dose of dopamine 3 ~ 5 μg · kg-1 · min -1, respectively, in the cut skin, into the abdominal exploration, hepatic blood flow before blocking, 5min after blocking, 10min after blocking, liver blood flow 5min after open and at each time point to take arteries for blood gas analysis. Results The residual base (BE) decreased 5 min after the hepatic blood flow was opened compared with that before occlusion (P <0.05), and the pH, the actual bicarbonate concentration (AB), the carbon dioxide binding capacity Bicarbonate concentration (SB), oxygen saturation (SaO2) and other changes in the block before and after little. Conclusion Transabdominal hepatic blood flow blocking hepatectomy as long as the maintenance of hemodynamics is relatively stable and adequate visceral perfusion, without the need for routine replacement of alkaline drugs, is conducive to postoperative recovery.