| Objective: To explore the influence of low central venous pressure(LCVP)to immune function and prognosisin patientsundergoing hepatolobectomy.Methods: A total of forty liver cancer patients undergoing selective hepatolobectomy between October,2016 and January,2017 in our hospital were enrolled in this prospective study.These patients were randomly divided into two groups: normal control group(group P)(n = 20)and LCVP group(group C)(n = 20).All of them in these two groups were received the same measures of anesthesia and operation.The mean blood pressure(MAP)and heart rate(HR)were recorded at six points of time,including 3 min before the operation(T1),3 min after theinduction(T2),3 min before thehepatic portal occlusion or 3 min before the CVP decline(T3),3 min after the liver lobe resection(T4),the end of operation(T5),24 h after operation(T6).All adverse effects,use of any vasoactive drugs,volume of transfusion including fluid and blood,urine input and blood loss associated with recovery and the intraoperativeuses of any vasoactive drugs were simultaneouslynoted.Then,the concentration of interleukin(IL)-4,interferon(IFN)-? and transcription growth factor(TGF)-?1 in serum of both groups were assessed by enzyme linked immunosorbent assay at these six time points.The level of hepatic transaminase including ALT and AST,and immune function were compared between C and P group at baseline and the third day after operation.Results:Hemodynamic changes: At T4 time point,the HR in C group was higher than that in P group,but the MAP in C group was lower than that in P group(both P< 0.05)with the fluctuation in the normal range of values.There were no statistical difference in the comparison between other time points(both P>0.05).Fluid transfusion: Compared with P group,the total volume of fluid infusion,blood loss,transfusion and urine inputin C group were significantly decreased(both P< 0.05).ALT and AST changes: The level of ALT and AST at baseline and the third day after operation between C and P groups were similar(both P>0.05).Compared with the baseline value,the level of ALT and AST at the third dayafter operation were both significantly increased in each group(both P<0.05).Immune function: The level of IgG ? IgM and IgA at the third day after operation were both significantly decreased in comparison with baseline value in C and P group(both P< 0.05),but the level of IgG?IgM and IgA at baseline and the third day after operation between C and P groups were similar(both P>0.05).The value of CD3+,CD3+CD4+,CD3+CD8+ and CD19+ at baseline and the third day after operation between C and P groups were similar(both P>0.05).The level of CD3-CD16+CD56+ at the third day after operation were both significantly decreased in comparison with baseline value in C and P group(both P< 0.05),and the decline in P group were more severe than that in C group(P< 0.05).The level of CD3+CD4+/CD3+CD8+ at the third day after operation were significantly up-regulated in comparison with baseline value in C group(P< 0.05).Inflammatory factors: The level of IL-4 at T4 and T5 time points were significantly lower than that at T1 time point in C group,and the level of IL-4 at T6 time point in P group were decreased compared with other time points(both P< 0.05).Between P and C group,the expression of IL-4 at T5 time point in C group were significantly lower than that in P group(P< 0.05).The expression of IFN-?at T6 time point in P group was up-regulated in comparison with T2,T3 and T4 time points(both P< 0.05),and there were no statistical difference in the comparison between other time points(both P> 0.05).Interestingly,there were no statistical difference observed for the expression of TGF-?1 between groups and any time points(both P> 0.05).Conclusion:The change of IL-4 in LCVP group were more obvious compared with normal CVP.The LCVP group has protective effect on immune function. |
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