| Objective To observe the influence of controlled low central venous pressure(CLCVP) on biochemical indicators and correlated clinical recovery indicators of patients undergoing liver transplantation. To assess the protection of CLCVP on liver and kidney.Methods The treatment plan in this study was checked out by ethics committee of the first affiliated hospital of Chongqing medical university. All data of adult orthotopic liver transplantation (OLT) recipients were reviewed from 2003.02 to 2010.03. Depleted the ones who combined with primary or secondary pulmonary and kidney diseases. Forty-eight patients undergoing non-bypass OLT were divided into two groups:normal central venous pressure(CVP) group(group C, n=25), CLCVP group(group L,n=23). In group C, no efforts were made to lower CVP, patients were maintained with "normal" hemodynamics, namely CVP 8～12 cmH20 and mean arterial pressure (MAP) 60～80 mmHg. In group L, patients were maintained a CVP 3～5 cmH2O and MAP≥80 mmHg during preanhepatic stage and reperfusion stage by minimizing fluid administration (3～5 ml.kg-1.h-1), using nitroglycerin (2～5μg.kg-1.min-1) and dopamine (2～10μg.kg-1.min-1). Data collected included general informations, input and output during operation. Alanine aminotrasferase (ALT), glutamic oxalacetic transaminase(AST), prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(Fg), creatinine(Cr) and blood urea nitrogen(BUN) were recorded at the time of before anesthetize(T0),5min(T1),2h(T2),5h(T3),12h(T4),24h(T5),48h(T6) and 72h(T7) after liver reperfusion. Recovery time of ATL and AST back to normal, volume and time of abdominal drainage, ventilation time, pulmonary complications, acute renal disfunction(ARD) rate and blood purification therapy, length of stay in ICU and hospital after operation were recorded.Results (1) General conditions:There were no significant difference in gender, age, body weight, etigology, Child-Pugh classification and operation time between two groups(P>0.05).(2) Input and output during operation:Compared with group C, blood loss, blood products transfusion and fluid transfusion were significantly decreased and urine output during reperfusion stage increased in group L(P>0.05).(3) Biochemical indicators of liver and renal function:①ALT and AST: Compared with T0, ALT increased at T1～7 and AST increased at T1～5 in both groups(P<0.05). Compared with group C, the time of ALT and AST decreased to normal were shorter(P<0.05).②PT, APTT and Fg:Compared with T0, PT became longer at T2 and shorter at T6,7 in group L (P<0.05), PT became longer at T1～3 and shorter at T7 in group C(P<0.05). Compared with To, APTT became longer at T1,2 and shorter at T6,7 in group L(P<0.05), APTT became longer at T1～3 and shorter at T7 in group C (P<0.05). Compared with T0, Fg decreased at T1～3 in group L and at T1～5 in group C(P<0.05). Compared with group C, Fg was higher at T5～7 in group L(P<0.05).③Cr and BUN:Compared with To, Cr increased at T2～7 in group L and at T1～7 in group C(P<0.05). Compared with group C, Cr decreased at T1,3～5 in group L(P<0.05). Compared with To, BUN decreased at T4～7 in group L and at T3～7 in group C(P<0.05). Compared with group C, BUN decreased at T4～7 in group L(P<0.05).(4) Clinical recovery indicators:Compared with group C, abdominal drainage volume were less and drainage time were shorter(P<0.05). Mechanical ventilation time and pulmonary infection rate were lower(P<0.05). ARD rate and blood purification therapy was less in group L(P<0.05). Length of stay in ICU and hospital after operation were shorter(P<0.05).Conclusions (1) CLCVP could reduce blood loss in liver transplantation to some extent. (2) CLCVP could protect liver and renal function to some extent, and it was benefit for postoperative recovery. |
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