Department of Anaesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
World J Surg. 2010 Aug;34(8):1864-73. doi: 10.1007/s00268-010-0544-y.
Although the low central venous pressure (LCVP) technique is used to decrease blood loss during liver resection, its efficacy and safety during transplant procedures are still debatable. Our study aimed to assess the effects of this technique and its clinical safety for recipients undergoing liver transplantation.
Eighty-six adult patients were randomly divided into a LCVP group and a control group. In the LCVP group, CVP was maintained below 5 mmHg or 40% lower than baseline during the preanhepatic phase by limiting infusion volume, manipulating the patient's posture, and administration of somatostatin and nitroglycerine. Recipients in the control group received standard care. Hemodynamics, blood loss, liver function, and renal function of the two groups were compared perioperatively.
A lower CVP was maintained in the LCVP group during the preanhepatic phase, resulting in a significant decrease in blood loss (1922 +/- 1429 vs. 3111 +/- 1833 ml, P < 0.05) and transfusion volume (1200 +/- 800 vs. 2400 +/- 1200 ml, P < 0.05) intraoperatively. Compared with the control group, the LCVP group had a significantly lower mean arterial pressure at 2 h after the start of the operation (74 +/- 11 vs. 84 +/- 14 mmHg, P < 0.05), a lower lactate value at the end of the operation (5.9 +/- 3.0 vs. 7.2 +/- 3.0 mmol/l, P < 0.05), and a better preservation of liver function after the declamping of the portal vein. There were no significant differences in perioperative renal function and postoperative complications between the groups.
The LCVP technique during the preanhepatic phase reduced intraoperative blood loss, protected liver function, and had no detrimental effects on renal function in LT.
尽管在肝切除术中使用低中心静脉压（LCVP）技术可以减少失血，但在移植手术中其疗效和安全性仍存在争议。本研究旨在评估该技术对接受肝移植受体的影响及其临床安全性。
86 名成年患者被随机分为 LCVP 组和对照组。在 LCVP 组中，通过限制输液量、调整患者体位、使用生长抑素和硝酸甘油，将 preanhepatic 期的 CVP 维持在 5mmHg 以下或比基线低 40%。对照组接受标准护理。比较两组患者围手术期的血流动力学、失血量、肝功能和肾功能。
LCVP 组在 preanhepatic 期维持较低的 CVP，导致术中出血量（1922 ± 1429 与 3111 ± 1833ml，P < 0.05）和输血量（1200 ± 800 与 2400 ± 1200ml，P < 0.05）显著减少。与对照组相比，LCVP 组在手术开始后 2 小时的平均动脉压较低（74 ± 11 与 84 ± 14mmHg，P < 0.05），手术结束时的乳酸值较低（5.9 ± 3.0 与 7.2 ± 3.0mmol/L，P < 0.05），门静脉阻断后肝功能保存更好。两组患者围手术期肾功能和术后并发症无差异。
在 preanhepatic 期使用 LCVP 技术可减少术中失血量，保护肝功能，对 LT 术后肾功能无不良影响。
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