Application Of Regional Approach To Hepatic Blood Flow Combined With Controlled Reduction Of Central Vein In Laparoscopic Hepatectomy

Object:To study the safety and efficacy of regional hepatic blood flow occlusion combined with controlled reduction of central venous pressure in laparoscopic hepatectomyMethod:Elderly patients who underwent open inguinal hernia repair and high ligation at the first affiliated hospital of bengbu medical college from January 2018 to June 2019 were selected.Patients were divided into experimental group(T:n=30)and control group(C:n=30)by random number table method,In the experimental group,ultrasound-guided transverse abdominal muscle block combined with iliac subabdominal ilioinguinal nerve block was used,and the ultrasound-guided transverse abdominal muscle block was given with ropivacaine at 0.4ml/kg concentration of 0.25%.Under ultrasound-guided ilioabdominoinguinal nerve block,ropivacaine with 0.25%concentration of 0.25ml/kg was given.In the control group,13-14 or 12-13 vertebral Spaces were selected for epidural puncture.After successful catheterization,the experimental dose of lidocaine was given.After excluding complications of spinal anesthesia,0.5%ropivacaine was injected into the epidural catheter with 15ml.To observe the effect of anesthesia in both groups,anesthesia operation time,adverse reaction to anesthesia,nausea and vomiting,local anesthetics poisoning,the incidence of urinary retention),record each time point(before anesthesia(T0),15 min after the anesthesia(T1),cut the skin(T2),the hernial sac mend(T3),the end of surgery(T4),6 h(T5)after operation,postoperative 12 h(T6),24 h after surgery(T7 has)elderly patients with mean arterial pressure(MAP),heart rate(HR),the change of VAS score·Result:There was no significant difference in general data between the two groups(P>0.05),153.33 ± 13.89 in the total operation time ? group(min,x+s),the? group 169.60±10.71(min,x+s)and duration of broken liver ? group 48.40 ±6.11(min,x+s),? group 58.00+±5.78(min,x+s),total blood loss ? group 213.33 ± 94.90(ml,x+s),the ? group 309.33 ± 68.79(min,x+s).Broken when liver blood loss ? group 79.53 ± 18.18(min,x+s),? group 110.67 ± 54.05(ml,x+s),intraoperative blood transfusion volume I group 147.33 ± 57.15(ml,x+s),?group 203.33 ± 68.10(ml,x+s),the first porta hepatis blocking time ? group 11.66± 2.39(min,x+s),? group 17.67±4.95(min,x+s),the ? group ? group were decreased significantly,the difference was statistically significant(P<0.05),PH 7.38±0.02 in T3 ? group(x?s),lactic acid value of 2.49±0.29(the tendency for the 1,x+s),? group of PH 7.34±0.02(x+s)and lactic acid value of 3.26±0.52(the tendency for the 1,x+s),the difference between the two groups was statistically significant(P<0.05),postoperative index ? group in postoperative hospital stay,postoperative intestinal function recovery time is shortened ? group,the difference was statistically significant(P<0.05),There were no significant differences in intraoperative urine volume,PH and lactic acid values(T1,T2,T4),and postoperative recovery of liver and kidney functions(P>0.05)Conclusion:Controlled low central venous pressure technique combined with regional hepatic blood flow blocking technique is safe and feasible,and can significantly reduce intraoperative bleeding,shorten the operation time,and improve the safety of laparoscopic hepatectomy.Meanwhile,controlled low central venous pressure technique is simple to operate,with little impact on liver and kidney functions,and is easy to be popularized.