The Clinical Study Of Application Of Controlled Low Central Venous Pressure In The Liver Surgery

PartⅠ Application of controlled low central venous pressure（CLCVP） in theprecision liver resectionObjective To evaluates the CLCVP effects on the blood loss and renal functionduring precision liver resection. Methods Fifty patients undergoing the precision liverresection surgery were randomly divided into LCVP group and control group. From theanesthesia induction to parenchymal dissection and hemostasis the patients of LCVPgroup maintenance of CVP lower then4mmHg by regulating dose of transfusion、adjusting the reverse-Trendelenberg position and using insoflurane and/or injectingnitroglycerin0.1-2μg/（kg.min）. After hemostasis were completed the CVP wasrecovered to the normal rang. The patients of control group maintenance of CVP on thenormal range. The blood loss, blood transfusion and variance of renal function of thepatients were recorded. Results The volumes of blood loss were lower in LCVP groupthan in control group (342.3±208.2ml vs648.4±381.2ml,P<0.05), and there was nostatistically significant difference was found in renal function between the two groups(P>0.05). Conclusion The CLCVP is obviously reduced the blood loss,and has nodetrimental effects on renal function in the precision liver resection surgery.PartⅡ Application of controlled low central venous pressure in large liverneoplasms surge ryObjective To evaluates the feasibility of CLCVP application in large liverneoplasms surgery, and effect on the change of renal function. Methods Twenty-fivepatients undergoing the large liver neoplasms surgery in our department. From theanesthesia induction to parenchymal dissection and hemostasis the patients maintenanceof CVP lower than5mmHg by regulating dose of transfusion、 adjusting thereverse-Trendelenberg position and using insoflurane and/or injecting nitroglycerin.After hemostasis were completed the CVP was restored to the normal rang. The blood loss, blood transfusion and variance of renal function of the patients were recorded.Results The volume of blood loss is1150±639.8ml,sixteen patients needed bloodtransfusion which was841±443.5ml;and there was no significant difference betweentwo groups in variance of renal function (P>0.05). Conclusion The CLCVP is availablein large liver neoplasms, and has no detrimental effects on renal function.PartⅡ Effects of controlled low central venous pressure on the heart ratevariability and hemodynamic in the hepatectomy surgeryObjective To analysis of effects of CLCVP on the HRV and hemodynamic in thehepatectomy surgery.Methods Twenty-night patients undergoing elective hepatectomysurgery under the venous-inhaled combined generous anesthesia during the operationreceived CLCVP. MBP、HR、BIS、HF、LF and HF/LF ratio were respectively recordedat10time points: before anesthesia(T0)，before deliberate hypotension(T1)， The CVPjust lower then5mmHg(T2)、5min(T3)、10min(T4) and15min(T5) after that; The CVPjust restored more than5mmHg (T6)、5min(T7)、10min(T8) and15min(T9) after that.Results Compared with T0, except T8the change of LF/HF was no statisticallysignificant difference from T1to T9. The HF was lower at T2to T5than that at T1（P<0.05）. LF/HF was higher at T4than that at T1and T2（P<0.05）,and at T5higherthan that at T2. HF was lower at T8than that at T6(P<0.05). LF/HF was higher at T8toT9than that at T6(P<0.05)；Heart rate was higher at T4than that at T0(P<0.05). Themean blood pressure at T1to T9was lower than T0(P<0.05).Conclusion Althoughpatients receiving the hepatectomy surgery under the venous-inhaled combinedgenerous anesthesia were given the CLCVP, from the CVP lower than5mmHg torecovered the sympathetic and parasympathetic tone basically maintained the dynamicbalance, and the hemodynamic not obviously changed.