The Effect Of Different Level Of Low Center Venous Pressure On Blood Loss In Hepatolobectomy

Objective:To investigate the effect of different level of low central venous pressure on the volume of blood loss,searching the optimal security value of low central venous pressure in hepatolobectomy.Methods:100 patients undergoing selective hepatolobectomy under general anesthesia,ASA classificationⅠ～Ⅱ,were randomly divided into five group:groupâ… ,CVP＝1mmHg(n＝20);groupâ…¡,CVP＝2mmHg(n＝20);groupâ…¢, CVP＝3mmHg(n＝20);groupâ…£,CVP＝4mmHg(n＝20);groupâ…¤,CVP＝5mmHg (n＝20).CVP was maintained at every group needed level by restricting transfusion and using diuretic and vasoactive drugs(eg,nitroglycerin,NTG) and so on,in maintenance of systolic blood pressure(SBP)≥90mmHg or mean arterial pressure(MAP)≥60mmHg during liver parenchyma resection.Blood pressure and heart rate were recorded in the preoperative,during liver parenchyma resection and postoperative.Blood loss before resection,during liver parenchyma resection and after resection were recorded respectively.The liver parenchyma transection area,the red blood cell(RBC) and plasma infusion, the transfusion before completing liver parenchyma transection were recorded. Blood loss per transection area were calculated(blood loss per transection area＝ blood loss during liver parenchyma resection/the liver parenchyma transection area).Results:1)There were no significant differences in five group on patient's sexes,age,weight,the urine,the site of resection,with or without cirrhosis, hepatic inflow blocking way,the tool of resection,hepatic inflow blocking time and the time of liver parenchyma resection(P＞0.05).2)The MAP before resection and after resection,and the HR before resection,during liver parenchyma resection and after resection were no significant differences in five group(P＞0.05);The MAP during liver parenchyma resection of groupâ… ,â…¡,â…¢,â…£and groupâ…¤were(77±7)mmHg,(75±9)mmHg,(80±9)mmHg,(82±8) mmHg,(83±13)mmHg(groupâ… vs groupâ…¤,groupâ…¡vs groupâ…£and groupâ…¤, respectively,P＜0.05).3)There were no significant differences in five group on blood loss before and after resection,the liver parenchyma transection area(P＞0.05);The blood loss during liver parenchyma resection of groupâ… ,â…¡,â…¢,â…£and groupâ…¤were 300(30～1600)ml,240(20～750)ml,400(100～1300)ml,500 (110～1350)ml,800(150～3250)ml(groupâ… ,â…¡and groupâ…¢vs groupâ…¤, groupâ…¡vs groupâ…£,respectively,P＜0.05);The blood loss per trans-ection area of groupâ… ,â…¡,â…¢,â…£and groupâ…¤was 5.2(1.11～13.59)ml/cm²,4.0(0.54～15.71)ml/cm²,5.7(1.22～11.71)ml/cm²,6.9(2.87～18.10)ml/cm²,12.6(2.78～29.82)ml/cm²(groupâ… ,â…¡and groupâ…¢vs groupâ…¤,groupâ…¡vs groupâ…£,respectively,P＜0.05).4)There were significant differences in five group on the red blood cell(RBC) and plasma infusion,the transfusion before completing liver parenchyma transection,the ratio of non-blood infusion(%)and the ratio of impact therapy(%)(P＜0.05);The RBC and plasma infusion in groupâ…¤were significantly more than groupâ… ,â…¡,â…¢,â…£(P＜0.05);The ratio of non-blood infusion in groupâ…¤(50%) were significantly lower than groupâ… (81.3%),â…¡ (100%),â…¢(75%),â…£(75%)(P＜0.05);The transfusion before completing liver parenchyma transection in groupâ…¤(1448±530)ml were significantly more than groupâ… (758₂63)ml,â…¡(633±226)ml,â…¢(620±209)ml,â…£(621±214)ml,and groupâ… (758±263)ml were more than groupâ…¢(620±209)ml,â…£(621±214)ml(P＜0.05);The ratio of impact therapy in groupâ… (60%),â…¡(63.6%) were significantly higher than groupâ…¢(11.1%),â…£(11.1%),â…¤(0%)(P＜0.05). 5)There were no significant differences in five group on Hb and Hct before and after operation(P＞0.05);The postoperative Hb and Hct were significantly less than the preoperative(P＜0.05).Conclusion:Our study suggests the controlled low central venous pressure may decrease the blood loss in hepatolobectomy and has no significant adverse effects on haemodynamics.The optimal security value of CVP in hepatolobectomyis 3mmHg.