Retrospective Analysis Of The Application Of Controlled Low Central Venous Pressure In Patients Undergoing Hepatic Segments Resection

Objective To analysis the complications in perioperative period for patients with hepatoma undergoing hepatic segments resection under low central venous pressure , and to evaluate the effect of low central venous pressure in the hepatic segments resection.Methods 610 patients with hepatoma undergoing hepatic segments resection in the First Affiliated Hospital of Guangxi Medical University during 2005 to 2009 were collected. All patients were divided into six groups according to the surgery methods: group A were undergoing single hepatic segments resection; group B were undergoing two hepatic segments resection; group C were undergoing various hepatic segments resection; group D were undergoing right hemihepatectomy; group E were undergoing left hemihepatectomy; group F were undergoing local excision of tumor. All patients at group A to F were redivided into low central venous pressure group(0 cmH2O≤CVP≤5cmH2O , group LCVP) and normal central venous pressure group(CVP>5cmH2O , group NCVP) according to the CVP during the liver parenchyma resection. The patient's sexes, age, weight, Hb, Hct,PLT, the grade of Child-Pugh before resection and renal dysfunction were recorded. The red blood cell(RBC) and fresh frozen plasma(FFP) infusion during intraoperative period and postoper- ative were recorded respectively. Intraoperative blood loss, urine volume, the transfusion and hypotension were recorded. Blood loss average 3 days after surgery ,the albumin, intake ICU,the grade of Child-Pugh,the length of stay (LOS) after surgery and other complications were recorded.Results 1)In groups A,B,C,D,E and F, there were no significant difference in LCVP and NCVP group on patient's sexes, age, weight, Hb, Hct,PLT, the grade of Child-Pugh before resection and renal dysfunction(P>0.05)2)Intraoperative phase: In group A, the transfusion, blood loss, FFP infusion and RBC in group LCVP were significantly less than group NCVP ,and the urine volume was significantly more than group NCVP(P<0.05),there was no significant difference on hypotension; In group B, the blood loss and RBC in group LCVP were significantly less than group NCVP, and the urine volume was significantly more than group NCVP(P<0.05), there were no significant difference on the transfusion, FFP infusion and hypotension; In group C, the blood loss in group LCVP was significantly less than group NCVP(P<0.05), there were no significant difference on the transfusion, urine volume, FFP infusion , RBC and hypotension; In group D, the transfusion and blood loss in group LCVP were significantly less than group NCVP, and the urine volume was significantly more than group NCVP(P<0.05), there were no significant difference on the FFP infusion , RBC and hypotension; In group E, the transfusion , blood loss and FFP infusion in group LCVP were significantly less than group NCVP, and the urine volume was significantly more than group NCVP(P<0.05), there were no significant difference on RBC and hypotension; In group F, the transfusion in group LCVP was significantly less than group NCVP, there were no significant difference on urine volume, blood loss, FFP infusion, RBC and hypotension. 3)Post operation : In group A,B,C,D and E, LOS after surgery in group LCVP was significantly shorter than that in group NCVP( P<0.05), there were no significant difference on blood loss after surgery, FFP infusion, RBC, Alb, the grade of Child-Pugh, renal dysfunction, intake ICU and other complications. In group B, RBC in group LCVP was significantly less than group NCVP; For group A and B, the postoperative pleural effusion in group LCVP was significantly less than group NCVP( P<0.05).4) Comprehensive comparison In 610 patients: the transfusion, blood loss in group LCVP were significantly less than group NCVP ,and LOS after surgery in group LCVP was significantly shorter than that in group NCVP( P<0.05), there were no significant difference on intake ICU and other complications.Conclusion Our study suggests the controlled low central venous pressure may decrease the blood loss and blood transfusion, reduce hospital stay after surgery, and has insignificant adverse effects on complication.