The Risk Of Gas Embolism And Brain Injury In Laparoscopic Hepatectomy Under Low Central Venous Pressure

Objective: To investigate the situation of gas embolism(GE)and the risk of brain injury in laparoscopic hepatectomy(LH)between low central venous pressure and normal central venous pressure.Methods: Eighty patients,selected in this study,ASA class I ～ III,Child-Pugh class A and B,undergoing elective laparoscopic liver resection,were randomly divided into low central venous pressure group(group L)and normal central venous pressure(N group),40 cases in each group.The incidence,grade,and duration of GE in the cardiac chambers were determined by transesophageal echocardiography(TEE).Postoperative neurological complications,postoperative hospital stay,preoperative and postoperative levels of S100 B protein and neuron-specific enolase(NSE)were noted.Results:(1)Based on per protocol analysis,the data from 66 patients were analyzed(Group L,n = 35,Group N,n = 31).(2)The incidence of GE were similar between the two groups,with 68.6% of patients in Group L and 67.7% of patients in Group N(P > 0.05).(3)The total duration of intraoperative GE in Group L was(8.25±14.08)min,longer than(2.93±5.96)min in Group N,and the difference was statistically significant(P < 0.05).(4)The incidence of grade 1 to 4 bubbles in Group L was 45.7%,48.6%,28.6% and 8.6%,respectively.The incidence of grade 1 to 4 bubbles in Group N was 38.7%,38.7%,22.6% and 12.9%,respectively.There was no significant difference in the incidence of all grades of bubbles between the two groups(P>0.05).There were 3 cases of left heart chambers GE in Group L and 0 cases in Group N.There was no significant difference in the occurrence of left heart chambers GE between the two groups(P>0.05).(5)There was no significant difference in the levels of S100 B protein and NSE before and after operation between the two groups(P>0.05).The postoperative S100 B protein levels in both groups were significantly higher than the preoperative levels.The postoperative NSE levels in Group L were significantly higher compared to the preoperative levels(P< 0.05),while in Group N there was no significant difference.(6)There was no significant difference in postoperative neurological complications,hospital stay,postoperative agitation between the two groups.Conclusion: In laparoscopic hepatectomy,compared with maintaining normal central venous pressure,the duration of GE was increased with low central venous pressure.There was no significant difference in the incidence of GE and the risk of brain injury between normal and low central venous pressures in LH.