Shih T-H, Tsou Y-H, Huang C-J, Chen C-L, Cheng K-W, Wu S-C, Yang S-C, Juang S-E, Huang C-E, Lee Y-E, Jawan B, Wang C-H, Chang K-A
Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Surgery and Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2018 Nov;50(9):2661-2663. doi: 10.1016/j.transproceed.2018.04.007. Epub 2018 Apr 11.
Blood loss during liver surgery is found to be correlated with central venous pressure (CVP). The aim of the current retrospective study is to find out the cutoff value of CVP and stroke volume variation (SVV), which may increase the risk of having intraoperative blood loss of more than 100 mL during living liver donor hepatectomies.
Twenty-seven adult living liver donors were divided into 2 groups according to whether they had intraoperative blood loss of less (G1) or more than 100 mL (G2). The mean values of the patients' CVP and SVV at the beginning of the transaction of the liver parenchyma was used as the cutoff point. Its correlation to intraoperative blood loss was evaluated using the χ test; P < .001 was regarded as significant.
The cutoff points of CVP and SVV were 8 mm Hg and 13% respectively. The odds ratio of having blood loss exceeding 100 mL was 91.25 (P < .001) and 0.36 (P < .001) for CVP and SVV, respectively.
CVP less than 5 mm Hg, as suggested by most authors, is not always clinical achievable. Our results show that a value of less than 8 mm Hg or SVV 13% is able to achieve a minimal blood loss of 100 mL during parenchyma transaction during a living donor hepatectomy. Measurements used to lower the CVP or increased SVV in our serial were intravenous fluids restriction and the use of a diuretic.
肝脏手术中的失血与中心静脉压（CVP）相关。本回顾性研究的目的是找出CVP和每搏量变异度（SVV）的临界值，这可能会增加活体肝供体肝切除术中出现超过100 mL术中失血的风险。
27名成年活体肝供体根据术中失血是否少于（G1组）或超过100 mL（G2组）分为两组。肝实质离断开始时患者的CVP和SVV平均值用作临界点。使用χ检验评估其与术中失血的相关性；P < 0.001被视为具有显著性。
CVP和SVV的临界点分别为8 mmHg和13%。CVP和SVV导致失血超过100 mL的比值比分别为91.25（P < 0.001）和0.36（P < 0.001）。
大多数作者建议的CVP低于5 mmHg在临床上并非总能实现。我们的结果表明，低于8 mmHg或SVV 13%的值能够在活体供体肝切除术中肝实质离断期间实现最少100 mL的失血。我们系列中用于降低CVP或增加SVV的措施是限制静脉输液和使用利尿剂。
