| Objective: To study the effect of low central venous pressure on intestinal barrier function of liver cirrhosis patients undergoing hepatolobectomy by observing the change of the activity of diamine oxidase and the concentration of D(-)-lactate in serum during perioperation.Methods:30 cases undergoing elective surgery for hepatolobectomy, ASAâ… -â…¡, were entered into this trial. 8 cases without liver cirrhosis were classified as low central venous pressure control group(groupâ… , n=8),22 cases with liver cirrhosis were randomly divided into low central venous pressure group (groupâ…¡, n=11) and normal central venous pressure group(groupâ…¢, n=11) . The CVP in group I and groupâ…¡were controlled at 0-4mmHg by restricted transfusion, adjust the body position and combining intravenously administering nitroglycerine and frusemide during liver parenchyma resection. The CVP in groupâ…¢were maintained at 5-10mmHg by conventional methods of transfusion. The mean arterial pressure(MAP) and heart rate(HR) were recorded at the following time points: before anesthesia(T1), 5 min after induction of anesthesia(T2), 5 min after the beginning of liver parenchyma resect (T3), the end of surgical procedure(T4) ,24 hours (T5) and 48 hours after operation(T6). The CVP were recorded at T1 to T4. Arterial blood gas analysis were determined at T2 and T4 and hemoglobin and haematocrit were determined at the same times. The concentrations of D(-)-lactate and the activity of diamine oxidase in serum were detected at T1, T4 ,T5and T6. The volume of blood loss and transfusion during operation were recorded.Results : Because of surgical reason, group There were one cases in groupâ… and three cases in groupâ…¡need total hepatic vascular occlusion, so the four cases excluded from the study, 26 cases were completed in the study.1. Compared to groupâ… , the volume of blood loss in groupâ…¡and groupâ…¢were significantly increased(P<0.05). Compared to groupâ… and groupâ…¡, the volume of plasma transfusion in groupâ…¢were significantly increased(P<0.05).2. Compared to T1, T5 and T6 in group I and groupâ…¢, MAP were significantly decreased at T2, T3 and T4 respectively (P<0.05). MAP at T2 in groupâ…¡was significantly lower than the rest of the time point (P<0.05).Compared to T6 in group I, HR were significantly decreased at T1 and T2 respectively (P<0.05). Compared to T3, T5 and T6 in groupâ…¡, HR were significantly decreased at T1, T2 and T4 respectively (P<0.05). HR at T5 and T6 in groupâ…¢were significantly higher than the rest of the time point (P<0.05).Compared to T4 in group I and groupâ…¡, CVP were significantly decreased at T1,T2 and T3 respectively (P<0.05). Compared to T1 in groupâ…¢, CVP were significantly increased at T2,T3 and T4 respectively (P<0.05).MAP and HR were no significant difference at each time point between various groups(P<0.05). CVP of groupâ…¢were significantly higher than group I and groupâ…¡respectively at T3(P<0.05).3.. HB and HCT were no significant difference at each time point between various groups(P<0.05). HB and HCT of group I, groupâ…¡and groupâ…¢at T0 were significantly lower than that at T4 respectively(P<0.05).4.The power of hydrogen(pH), base excess(BE) and standard bicarbonate(HCO3-) in groupâ…¡and groupâ…¢at T4 were significantly lower than that at T2 respectively(P<0.05).5. The concentrations of D(-)-lactate and the activity of diamine oxidase of group I, groupâ…¡and groupâ…¢were no significant difference between various time point. At each time point, the concentrations of D(-)-lactate and the activity of diamine oxidase in group I were significantly lower than that in groupâ…¡and groupâ…¢respectively(P<0.05).Conclusion :1. Patients with liver cirrhosis have presence of intestinal barrier dysfunction before hepatolobectomy.2. Controlled low central venous pressure does not significantly adverse influence on intestinal barrier function of patient with or without liver cirrhosis undergoing hepatolobectomy in perioperation.
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