Jones R M, Moulton C E, Hardy K J
University of Melbourne Department of Surgery, Victoria, Australia.
Br J Surg. 1998 Aug;85(8):1058-60. doi: 10.1046/j.1365-2168.1998.00795.x.
Any strategy to reduce blood loss in liver resection and decrease blood transfusion would be of benefit to the patient and surgeon. This study evaluates the association of central venous pressure (CVP) with blood loss and blood transfusion during liver resection.
One hundred consecutive hepatic resections in the period 1986-1996 were studied prospectively concerning CVP, volume of blood lost, and volume of blood transfused. Blood loss volume and blood transfusion were analysed for those with a CVP less than or equal to 5 cmH2O, and greater than 5 cmH2O. A multivariate analysis assessed potential confounding factors in the comparison.
The median blood loss in patients with a CVP of 5 cmH2O or less was 200 ml (n=40) and that in those with a CVP above 5 cmH2O was 1000 ml (n=52) (P=0.0001). Only two of 40 patients with a CVP of 5 cmH2O or less had a blood transfusion whereas 25 of 52 patients with a CVP greater than 5 cmH2O required a transfusion (P=0.0008). A multivariate analysis did not show confounding factors.
The volume of blood lost during liver resection correlates with the CVP. Lowering the CVP to less than 5 cmH2O is a simple and effective way to reduce blood loss during liver surgery.
任何减少肝切除术中失血及减少输血的策略都将对患者和外科医生有益。本研究评估肝切除术中中心静脉压（CVP）与失血及输血之间的关联。
对1986年至1996年期间连续进行的100例肝切除术患者的CVP、失血量和输血量进行前瞻性研究。对CVP小于或等于5 cmH₂O和大于5 cmH₂O的患者的失血量和输血量进行分析。多因素分析评估了比较中的潜在混杂因素。
CVP为5 cmH₂O或更低的患者中位失血量为200 ml（n = 40），CVP高于5 cmH₂O的患者中位失血量为1000 ml（n = 52）（P = 0.0001）。CVP为5 cmH₂O或更低的40例患者中只有2例输血，而CVP大于5 cmH₂O的52例患者中有25例需要输血（P = 0.0008）。多因素分析未显示混杂因素。
肝切除术中的失血量与CVP相关。将CVP降低至小于5 cmH₂O是减少肝手术中失血的一种简单有效的方法。
