目的 探讨低中心静脉压(LCVP)对肝癌肝切除术的影响及意义。方法 选择我院2010年3月—2012年3月期间拟行肝切除术的原发性肝癌患者60例,随机分为LCVP组(30例)和NCVP(30例)。LCVP组术中采用相关技术控制CVP<0.5 kPa;NCVP组术中CVP和血压控制在基础值10%上下范围内。两组的麻醉方法、切口、切肝方法、输血指征均一致。分别记录:心率、血压、CVP值和血常规;手术时间、手术切除肝组织范围、手术期间各阶段出血量、输注血制品的数量;术后第1、3、7天的肝肾功能以及凝血功能,所需补充的外源性白蛋白量;术后并发症的发生率、住院时间和费用。结果 ①2组术前一般临床资料比较均无差异(均P>0 05)。②LCVP组手术时间、手术总出血量、肝离断时出血量、RBC输注量均低于NCVP组(P<0.05);③2组术后肝功能、肾功能指标比较无差异(P>0.05),LCVP组患者术后白蛋白补充量比NCVP组减少(P<0.05);④2组患者术后肝功能衰竭、膈下积液、胆瘘、大量腹水、肺部感染、空气栓塞、死亡的发生率比较,均无差异(P>0.05);⑤LCVP患者住院天数、住院总费用均比NCVP组减少(P<0.05)。结论 术中应用LCVP可减少肝癌肝切除术中出血量,缩短住院时间和住院费用,有利于患者的术后恢复。

Objective To evaluate the effect of LCVP applied during the operation of hepatectomy.Methods Sixty patients underwent hepatectomy were enrolled in the study from March 2010 to March 2012 in our hospital which were randomized into LCVP group and normal CVP (NCVP) group by the sealed envelope method. CVP was kept<0.5 kPa during entire procedure of hepatectomy in LCVP group, and the value of CVP and blood pressure were controlled within 10% of the baseline. The same anesthesia, incision and hepatectomy technique and indications of blood transfusion in LCVP group were undertaken as those in NCVP group. Intraoperative CVP, blood pressure, HR and blood routine were recorded. The time of operation, the amount of bleeding, the extent of removed hepatic tissue, the amount of transfused blood products,liver and renal function index, and coagulation function index were detected on the 1st, 3rd and 7th day after operation. Also the supplement of albumin, the rate of postoperation complications and the length of hospital stay and the expense in hospital were recorded.Results ① The general clinical data of patients were similar in the two group (P>0.05). ② The operation time, total bleeding volume, bleeding volume and RBC infusion volume in LCVP group were significantly lower than those in group NCVP (P<0.05). ③ There were no significant difference of postoperative liver and renal function index between the two groups (P>0.05). But the supplement of albumin in LCVP group after operation was significant less than that in NCVP group (P<0.05). ④ There were no significant difference of the postoperative complication, the length of hospital stay and the expense in hospital between the two groups (P>0.05).Conclusions The application of LCVP in hepatectomy cause less blood loss, shorten the length of hospital stay and decrease the expense in hospital, which is beneficial for the postoperative recovery.

       目的   探讨机械通气危重患者卧位与中心静脉压（CVP）的关系。方法   选取2022年1月—2024年1月开封市中医院收治的110例机械通气危重患者作为研究对象进行回顾性分析，依照患者不同卧床体位进行分组，分为平卧位组（n=20）、30°卧位组（n=30）、45°卧位组（n=40）、60°卧位组（n=20），分析机械通气危重患者卧位与中心静脉压的关系。结果   不同体位患者呼吸频率（RR）、心率（HR）、血氧饱和度（SpO₂）、平均动脉压（MAP）比较差异无统计学意义（P＞0.05），不同体位患者CVP水平比较差异有统计学意义，平卧位组更高（P＜0.05）；Spearman相关分析结果表明，RR、HR、SpO₂、MAP与体位无相关性（P＞0.05），CVP与体位角度呈负相关（P＜0.05）；体位一直无变化的患者5 min、10 min CVP差值比较差异无统计学意义（P＞0.05），5 min内变化体位与5~10 min变化体位患者CVP差值有所变化（P＜0.05）；CVP水平可随着体位角度增加而降低，随着呼气末正压（PEEP）水平升高而升高（P＜0.05）。结论   机械通气危重患者CVP可随着体位及PEEP水平变化而发生改变，因此针对患者监测CVP过程中可尽量让患者保持平卧位5 min后，且确保每次监测过程中PEEP稳定时进行CVP监测，可在监测后再对患者进行体位调整，确保CVP数据准确的同时，提升患者舒适度。

       Objective  To explore the relationship between lying angle and central venous pressure（CVP）in critically ill patients undergoing mechanical ventilation．Methods  A  retrospective analysis was conducted on 110 critically ill patients with mechanical ventilation admitted to the hospital from January 2022 to January 2024．The patients were divided into three groups based on their different bed positions：supine position group（n=20），30° lying angle group（n=30），45° lying angle group（n=40），and 60° lying angle group（n=20）．The relationship between CVP and lying angle of patients were compared．Results  There was no significant difference in respiratory rate（RR），heart rate（HR），blood oxygen saturation（SpO₂），and mean arterial pressure（MAP）between patients in different lying angle（P＞0.05），and there was a significant difference in CVP among patients in different lying angle．The supine position group had a significantly higher CVP（P＜0.05）．The Spearman correlation analysis results showed that RR，HR，SpO₂，MAP were not significantly correlated with lying angle（P＞0.05），while CVP was negatively correlated with body lying angle（P＜0.05）．There was no significant difference（P＞0.05）in CVP between 5 minutes and 10 minutes in patients with no changes in lying angle，while patients with changes in lying angle within 5 minutes and those between 5 minutes and 10 minutes showed significant changes（P＜0.05）．CVP levels decreased with increasing lying angle and increased with increasing PEEP level（P＜0.05）．Conclusions  The CVP of critically ill patients undergoing mechanical ventilation can change with lying angle and PEEP level．Therefore，during the monitoring of CVP for patients，it is advisable to keep them in a supine position for 5 minutes and ensure that PEEP is monitored simultaneously during each monitoring process．After monitoring，the patient’s posture can be adjusted to ensure accurate CVP data and improve patient’s comfort level．