Ryckx Andries, Christiaens Claudine, Clarysse Mathias, Vansteenkiste Franky, Steelant Pieter Jan, Sergeant Gregory, Parmentier Isabelle, Pottel Hans, D'Hondt Mathieu
Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium.
Department of Nephrology, Groeninge Hospital, Kortrijk, Belgium.
Ann Surg Oncol. 2017 May;24(5):1367-1375. doi: 10.1245/s10434-016-5737-7. Epub 2017 Jan 4.
Intraoperative hypovolemic phlebotomy (HP) has been suggested to reduce central venous pressure (CVP) before hepatectomy. This study aimed to analyze the impact of CVP drop after HP on intraoperative blood loss and postoperative renal function.
A retrospective review of a prospective database including 100 consecutive patients (43 males and 57 females; mean age, 65 years; range 23-89 years) undergoing liver resection with HP was performed. The primary outcome variable was estimated blood loss (EBL), and the secondary outcome was postoperative serum creatinin (Scr). A multivariate linear regression analysis was performed to identify predictors of intraoperative blood loss.
The median CVP before blood salvage was 8 mmHg (range 4-30 mmHg). The median volume of hypovolemic phlebotomy was 400 ml (range 200-1000 ml). After HP, CVP decreased to a median of 3 mmHg (range -2 to 16 mmHg), resulting in a median CVP drop of 5.5 mmHg (range 2-14 mmHg). The median EBL during liver resection was 165 ml (range 0-800 ml). The median preoperative serum creatinin (Scr) was 0.82 g/dl (range 0.5-1.74 g/dl), and the postoperative Scr on day 1 was 0.74 g/dl (range 0.44-1.68 g/dl). The CVP drop was associated with EBL (P < 0.001). There was no significant impact of CVP drop on postoperative Scr.
A CVP drop after HP is a strong independent predictor of EBL during liver resection. The authors advocate the routine use of HP to reduce perioperative blood loss and transfusion rates in liver surgery. As a predictive tool, CVP drop might help surgeons decide whether a laparoscopic approach is safe.
术中低血容量性静脉放血（HP）已被建议用于在肝切除术前降低中心静脉压（CVP）。本研究旨在分析HP后CVP下降对术中失血和术后肾功能的影响。
对一个前瞻性数据库进行回顾性分析，该数据库包括100例连续接受HP肝切除术的患者（43例男性和57例女性；平均年龄65岁；范围23 - 89岁）。主要结局变量是估计失血量（EBL），次要结局是术后血清肌酐（Scr）。进行多因素线性回归分析以确定术中失血的预测因素。
血液回收前CVP的中位数为8mmHg（范围4 - 30mmHg）。低血容量性静脉放血的中位数体积为400ml（范围200 - 1000ml）。HP后，CVP降至中位数3mmHg（范围 - 2至16mmHg），导致CVP中位数下降5.5mmHg（范围2 - 14mmHg）。肝切除术中EBL的中位数为165ml（范围0 - 800ml）。术前血清肌酐（Scr）的中位数为0.82g/dl（范围0.5 - 1.74g/dl），术后第1天的Scr为0.74g/dl（范围0.44 - 1.68g/dl）。CVP下降与EBL相关（P < 0.001）。CVP下降对术后Scr无显著影响。
HP后CVP下降是肝切除术中EBL的强有力独立预测因素。作者主张在肝手术中常规使用HP以减少围手术期失血和输血率。作为一种预测工具，CVP下降可能有助于外科医生决定腹腔镜手术方法是否安全。
