Effect Of Acute Normovolemic Hemodilution Combined With Controlled Low Central Venous Pressure On Cerebral Oxygen Metabolism And Splanchnic Perfusion In Patients Undergoing Hepatic Resection

Objective To investigate effect of acute normovolemic hemodilution（ANH） combined withcontrolled low central venous pressure（LCVP） on cerebral oxygen metabolism and splanchnicperfusion in patients undergoing hepatic resection. Methods Sixty ASAâ…  o râ…¡ patients, aged35⁷1yr, body mass index18²8kg/m², scheduled for hepatic resection,were randomly dividedinto3groups（n﹦20each）:control group（group Ⅰ）, LCVP group（group Ⅱ） and ANH combinedwith LCVP group（group Ⅲ）. Group â… r eceived no ANH and LCVPwith a5¹2cmH₂O centralvenous pressure during the whole process of surgery.In group â…¡, limit the volume of fluidinfusion,isoflurane inspiration and venous injection of nitroglycerin were applied to keep CVP at2⁵cmH₂O until hepatic parenchymal transaction, then rapid infusion proceeded until CVPrecovered. In group â…¢, ANH was applied with6%HES producing the hematocrit（Hct） of30%after intubation, the other dealing was given the same as the group â…¡. The blood samples weretaken from radial artery and jugular bulb simultaneously before hemodilution（T1）, induction of lowCVP（T₂）, CVP was recovered（T₃） and at the end of operation（T₄） for blood gas analysis. Oxygencontent of artery blood（CaO₂）, oxygen content of jugular bulb blood（CjvO₂）, arterial-jugular bulbvenous oxygen content differences（Da-jvO₂）, cerebral oxygen extraction ratio（CERO₂） andarterial-jugular bulb venous lactate concentration differences（VADL） were calculated. gastricmucosal pH（pHi） was determination with gastric tonometry. Blood loss and allogeneic bloodtransfusion were recorded. Results1．Blood loss, allogeneic blood transfusion and the numberof allogeneic blood transfusion were greater in group â… t han in the other groups.Allogeneic bloodtransfusion and the number of allogeneic blood transfusion were less in group â…¢ than in groupⅡ（P＜0.05）.2．Compared with groupâ… , CaO₂was increased at T_3,4in group â…¡, CaO₂and Da-jvO₂were decreased at T_2,3, CjvO₂was decreased at T₂, CaO₂and CjvO₂were increased at T4ingroup â…¢. Compared with group â…¡, CaO₂, CjvO₂and Da-jvO₂were decreased at T2,3in group â…¢.CERO₂was decreased at T3and T4in the three groups（P＜0.05）. SjvO₂,VADL and pHi werestill within normal range and no significant change between and within the three groups（P＞ 0.05）. Conclusion Moderate ANH combined with LCVP can decrease blood loss andallogeneic blood transfusion, having no effect on cerebral oxygen metabolism and splanchnicperfusion in patients undergoing hepatic resection.