The Clinical Study On The Application Of Controlled Low Central Venous Pressure In Laparoscopic Hepatectomy

Objective:To investigate the relationship between central Venous pressure（CVP）and intraoperative blood loss in patients during laparoscopic hepatectomy（CLCVP）and its application value.Selection methods:All of 61 cases of laparoscopic hepatectomy were selected from the Second Department of General Surgery,The First Affiliated Hospital of Dali University from September 2018 to December 2021.According to the total intraoperative blood loss,the patients were divided into the intraoperative blood loss≤200ml group and the intraoperative blood loss>200ml group.The operative time,intraoperative CVP size,relationship between CVP and blood loss,factors affecting intraoperative bleeding,postoperative outcome,postoperative complications and postoperative hospital stay were analyzed in the two groups,providing reference for safe and effective intraoperative use of CLCVP technology.Results:In laparoscopic hepatectomy,the CVP was（4.33±2.03）cm H₂O at the time of liver resection in the group with less than 200 ml of intraoperative bleeding,and the CVP was（4.33±2.03）cm H₂O at the time of liver resection in the group with appropriate hepatic blood flow occlusion and controlled Central venous pressure technique The CVP value during liver resection was（7.76 soil 2.65）cm H₂O,（t=-5.54,p<0.001）.The time of operation was shorter in the group with blood loss≤200ml than that in the group with blood loss≤200ml（p<0.001）.There was significant difference in the proportion of operation difficulty between the two groups（p<0.001）.A binary logistic regression analysis showed that,the influence of CVP size and operation time on intraoperative bleeding was statistically significant（or=2.061,95%CI 1.403-3.028,p=0.001）,（or=1.015,95%CI 1.002-1.028,P=0.022）.The liver function recovered faster in the group with less bleeding（p<0.001）,there was no significant difference in renal function between the two groups（P>0.05）,and there was no significant difference in hospital stay between the two groups（P>0.05）There was no significant difference in the ratio of postoperative complications between the two groups（P>0.05）.Conclusion:In laparoscopic hepatectomy,controlled Central venous pressure after appropriate hepatic blood flow occlusion was used,and the group with less blood loss was found to have lower CVP,the amount of intraoperative bleeding is correlated with CVP and operation time.Decreasing CVP can not only reduce the amount of intraoperative bleeding and transfusion rate,but also speed up the operation progress and reduce the operation time It can accelerate the recovery of liver function after operation,but has no obvious effect on renal function.The data from this study support the simplicity,safety and effectiveness of controlled Central venous pressure in the case of hepatic vascular occlusion.