Application Of Controlled Hypotension Combined With Controlled Low Central Venous Pressure In The Hepatic Resection

Objective:To observe the effect of controlled hypotension combined with controlled low central venous pressure on amount of bleeding,time of clamping porta hepatis and liver and kidney function postoperative in patients undergoing hepatic resection.Method:Select 40 patients needed liver resection from October 2013-March 2014 to enroll in the study and all patients were consistent with the diagnostic standard of primary liver cancer and without operation contraindication,ASA I-II grade,and the operations were finished by same doctors.40 patients were divided into two groups with 20 patients in each group according to the matching design of grouping.40 cases of patients connected the monitor for monitoring of vital signs and underwent invasive arterial monitoring and central venous pressure?CVP?monitoring.Two groups were given tracheal intubation general anesthesia.Give dexmedetomidine,penehycidine hydrochloride,fentanyl,propofol,cisatracurium for anesthesia induction,then pump casting propofol 4-10mg/kg·h,remifentanil 20?g/kg·h,cisatracurium 0.15mg/kg·h to maintain depth of anesthesia.The observation group adopted controlled hypotension combined with controlled low central venous pressure with preoperative restriction of fluid input,and pump casting esmolol0.1-0.8mg/kg·h and nitroglycerin 0.06-0.2mg/kg·h to maintain CVP among1-4cmH₂O and systolic pressure in 90-100mmHg,and maintain urine volume?1ml/Kg·h.If urine volume<30ml/h,give rapid infusion of liquid crystal 200-300ml.The observation group adopted appropriate restriction of fluid input before tumor excision and completing bleeding,then stop hypotension after completing bleeding and adopted rapid infusion of crystalloid and colloid fluid to recovere normal levels of systolic blood pressure,CVP.The control group took the controlled hypotension with no restriction of fluid input,adopt esmolol 0.1-0.8mg/kg·h and nicardipine0.03-0.1mg/kg·h to control systolic blood pressure in 90-100mmHg and CVP5-10cmH₂O.Stop hypotension after completing bleeding and appropriate input liquid for maintaining systolic blood pressure and central vein in normal range.Statistics amount of bleeding,operation time,time of hepatic portal occlusion,the volume of blood transfusion;blood transfusion volume between two groups.Then extract arterial blood for blood gas analysis from two patients to compare hemoglobin level,hematocrit pre-operation and post-operation.The patients of two groups adopt blood biochemical examination before operation,postoperative 1d,3d,7d,then to compare of serum bilirubin,plasma albumin,prothrombin time index for the assessment of liver function;and before the operation,postoperative 1d,3d,7d determinate urea nitrogen,creatinine level for renal function assessment.Results:1)The average age,general composition,grade of ASA,tumor location,tumor size,preoperative hemoglobin level had no significant difference between two groups,P>0.05.2)The observation group'bleeding amount,time of hepatic portal occlusion,operation time and postoperative blood transfusion were significantly lower than those in control group,P<0.05.3)The observation group'postoperative hemoglobin level,hematocrit were significantly higher than those of the control group,and were lower than preoperative level,P<0.05.4)The two groups'plasma albumin,serum bilirubin,prothrombin time postoperative 1d,3d,7d had no significant statistic difference,P>0.05;and there was no significant difference compared with preoperative level,P>0.05.Two groups of patients had not ascites,hepatic encephalopathy postoperative.Two groups of patients'blood urea nitrogen,creatinine levels had no statistically significant differences postoperative 1d,3d,7d,P>0.05;andthere was no significant difference compared with preoperative level,P>0.05.Conclusion:Controlled hypotension combined with controlled low central venous pressure in hepatic resection can significantly reduce the amount of bleeding,and it can shorten the time of hepatic portal occlusion operation and reduce bleeding time,amount of blood transfusion.Function of liver and kidney after operation had no significant influence,so the clinical application is safe and has important clinical value.