Department of Anesthesiology and Department of Hepatic and Biliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
Hepatobiliary Pancreat Dis Int. 2013 Oct;12(5):520-4. doi: 10.1016/s1499-3872(13)60082-x.
Low central venous pressure (CVP) affects hemodynamic stability and tissue perfusion. This prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma (HCC).
Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal transection. The systolic blood pressure (SBP) was maintained, if possible, at 90 mmHg or higher. Hepatitis B surface antigen was positive in 90 patients (92.8%) and cirrhosis in 84 patients (86.6%). Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 minutes. The average clamp time was 21.4+/-8.0 minutes. These patients were divided into 5 groups based on the CVP: group A: 0-1 mmHg; B: 1.1-2 mmHg; C: 2.1-3 mmHg; D: 3.1-4 mmHg and E: 4.1-5 mmHg. The blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were analyzed.
With active fluid load, a constant SBP ≥90 mmHg which was considered as optimal was maintained in 18.6% in group A (95% CI: 10.8%-26.3%); 39.2% in group B (95% CI: 29.5%-48.9%); 72.2% in group C (95% CI: 63.2%-81.1%); 89.7% in group D (95% CI: 83.6%-95.7%); and 100% in group E (95% CI: 100%-100%). The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in CVP. Compared to groups D and E, blood loss in groups A, B and C was significantly less (analysis of variance test, P<0.05). Compared with the baseline, the blood oxygenation decreased significantly when the CVP was reduced. Base excess and HCO3- in groups A and B were significantly decreased compared with those in groups C, D and E (P<0.05).
In consideration of blood loss, SBP, base excess and HCO3-, a CVP of 2.1-3 mmHg was optimal in patients undergoing partial hepatectomy for HCC.
低中心静脉压（CVP）会影响血流动力学稳定和组织灌注。本前瞻性研究旨在评估肝细胞癌（HCC）部分肝切除术中的最佳 CVP。
97 例行 HCC 部分肝切除术的患者在肝实质切开时将 CVP 控制在 0 至 5mmHg 之间。如果可能，将收缩压（SBP）维持在 90mmHg 或更高。90 例患者（92.8%）乙型肝炎表面抗原阳性，84 例患者（86.6%）肝硬化。这些患者常规使用普雷尔手法，夹闭/松开循环为 15/5 分钟。平均夹闭时间为 21.4+/-8.0 分钟。根据 CVP 将这些患者分为 5 组：A 组：0-1mmHg；B 组：1.1-2mmHg；C 组：2.1-3mmHg；D 组：3.1-4mmHg；E 组：4.1-5mmHg。分析肝实质切开时每切开面积的失血量和肝切开前后的动脉血气。
在积极的液体负荷下，18.6%的 A 组（95%CI：10.8%-26.3%）、39.2%的 B 组（95%CI：29.5%-48.9%）、72.2%的 C 组（95%CI：63.2%-81.1%）和 89.7%的 D 组（95%CI：83.6%-95.7%）维持了≥90mmHg 的目标 SBP（考虑到主动液体负荷，SBP≥90mmHg 被认为是最佳的）。E 组（95%CI：100%-100%）的 100%患者达到了目标 SBP。肝实质切开时每切开面积的失血量随 CVP 的降低而减少。与 D 组和 E 组相比，A、B 和 C 组的出血量明显减少（方差分析检验，P<0.05）。与基线相比，当 CVP 降低时，血氧饱和度显著降低。与 C、D 和 E 组相比，A 组和 B 组的碱剩余和 HCO3-明显降低（P<0.05）。
考虑到出血量、SBP、碱剩余和 HCO3-，在 HCC 部分肝切除术中，CVP 为 2.1-3mmHg 时最佳。
