The Study On The Tolerance Of Controlled Low Central Venous Pressure In Patient Undergoing Hepatolobectomy

Objective: To investigate the tolerance of controlled low central venous pressure and the effect of LCVP on blood loss and arterial blood gas analysis in patients undergoing hepatolobectomy.Methods: 97 liver cancer patients, ASA classificationⅠ～Ⅱ, undergoing selective hepatolobectomy under general anesthesia were controlled CVP at the possible lowest level (>0～≤5mmHg) before hepatic parenchymal transection and maintained CVP at this level during the process of hepatic parenchymal transection and maintained the systolic blood pressure≥90mmHg by restricted transfusion, using diuretic and administrating of vasoactive drugs (Nitroglycerin, NTG) and so on. The CVP, SBP, DBP, MAP, HR during hepatic parenchymal transection were recorded. According to the patient's CVP value during hepatic parenchymal transection, all patients were divided into 5 groups, group A:CVP was 1mmHg; group B: CVP was 2 mmHg; group C: CVP was 3 mmHg; group D: CVP was 4 mmHg; group E: CVP was 5 mmHg. The blood loss per transection area during hepatic parenchymal transection (blood loss per transection area=volume of blood loss during hepatic parenchymal transection÷cross section area of hepatic parenchymal transection) and the results of arterial blood gas analysis before and after hepatolobectomy were compared respectively. The patient's tolerances of LCVP were evaluated by the volume of blood loss, the CVP and the results of arterial blood gas analysis.Results: 1.The state of patient's tolerance of LCVP: at the premise of SBP≥90mmHg, all of the patients can tolerate the CVP at 5mmHg, 89.69% (95%CI:83.64%～95.74%) of the patients can tolerate the CVP at 4mmHg, 72.16%(95%CI:63.24%～81.08%) of the patients can tolerate the CVP at 3mmHg, 39.18%(95%CI:29.47%～48.89%) of the patients can tolerate the CVP at 2mmHg, only 18.56%(95%CI:10.82%～26.30%) of the patients can tolerate the CVP at 1mmHg. 2.The effect of LCVP on the hemodynamics: all the patient's SBP, DBP, MAP and HR can be maintained in the clinical normal range during hepatic parenchymal transaction. The DBP, MAP of group A and B were significant lower than that of group C,D and E (P<0.05). 3. The blood loss per transection area and transfusion volume during hepatic parenchymal transection under different lever of LCVP: Compared with group D, E, the blood loss per transection area during hepatic parenchymal transection in group A,B,C were significant less (P<0.05). The transfusion volume in group A and B are more than that in group C,D,E respectively (P<0.05). 4. The effect of LCVP on the arterial blood gas analysis: (1)Compared with basic values, the BE,HCO3-in group A and B decreased more than group C,D,E(P<0.05), and the PH, SO2 and PO2 in each group were without significant differences (P>0.05); (2)the differences of BE values in group A and B are more than that of group C,D,E(P<0.05).Conclusion: Most patients can tolerate CVP at 3mmHg～5mmHg in hepatolobectomy. Control the CVP at 3mmHg can reduce the volume of blood loss mostly and it doesn't produce adverse effects on arterial blood gas analysis. The best safety value of LCVP in hepatolobectomy is 3mmHg.