Safety Evaluation Of Multi-mode Monitoring In Patients Undergoing Precision Liver Resection With Controlled Low Central Venous Pressure

Objective:To investigate the effect of CLCVP on intraoperative bleeding in patients undergoing liver resection and the safety of multi-modality testing in patients undergoing liver resection with CLCVP.Methods:Patients who underwent elective precision hepatectomy between March 2021and November 2022,ASA≤grade III,Child-Pugh score A,age 30-70 years,were randomized into three groups according to the 1:1:1 principle:blank control group（group I）;conventional method low central venous pressure group（group II）;and multi-modality detection controlled low central venous pressure group（group III）.Group I did not intervene in central venous pressure;Group II controlled reduction of CVP<5cm H₂O by conventional methods;Group III used cerebral oxygen saturation monitoring（r SO₂）,Li DCO,ultrasound measurement of neck vessels to assess cerebral blood flow multi-modality monitoring controlled reduction of CVP<5cm H₂O.three groups of indicators were observed:（1）observation and comparison of blood pressure,HR,CVP changes in the three groups of patients;（2）fluid in and out volume comparison such as:blood loss,urine volume,rehydration volume;（3）Observed values during surgery:such as hepatic portal group time,liver incision time,surgery time;（4）liver and kidney function and blood gas indexes before surgery and after 3 days after surgery:SCr,BUN,AST,ALT,TBIL,Pa O₂,Lac,Hb;（5）Time to first postoperative bed release and length of stay for the three groups of patients.Results:Forty-five patients undergoing elective surgery with precision liver resection under general anesthesia between March 2021 and November 2022 were included.（1）Inter-group comparison:no statistically significant differences in HR and MAP at different moments in the three groups（P>0.05）;intra-group comparison:no statistically significant differences in CVP at T1-T4 moments in group III patients（P>0.05）.Compared with the data at the moment of T0,the HR of patients in group I was significantly lower at T1 and T2（P<0.05）,and the HR of patients in group III was significantly lower at the moment of T1-T4（P<0.05）,and there was no statistically significant difference between the different moments of MAP in the three groups（P>0.05）;（2）Intra-group comparison:there was no statistically significant difference in the comparison of bleeding volume in the three groups（P>0.05）,and the patients in the three groups The difference in urine volume at different moments during surgery was not statistically significant（P>0.05）,compared with group I,the change in rehydration volume in group II and group III was significantly lower at the moment of T0-T2（P<0.05）and significantly increased at the moment of T3-T4（P<0.05）;（3）Comparison between groups:compared with group I,patients in groups II and III had significantly reduced time to hepatic portal block（P<0.05）,patients in group III had significantly reduced length of liver incision（P<0.05）,and there was no significant difference in the change of operative time and total length of hospital stay in the three groups（P>0.05）;（4）Comparison between groups:compared with group I,patients in group III had significantly reduced postoperative Lac（P<0.05）and significantly increased Pa O₂（P<0.05）.Intra-group comparison:Lac and SCr were significantly increased postoperatively in all three groups（P<0.05）;（5）Comparison between groups:Compared with group I,the postoperative getting out of bed time in groups II and III was significantly reduced（P<0.05）.Conclusion:There is no clear correlation between LCVP and decreased blood loss during hepatectomy,but LCVP can provide a clear surgical field and effectively shorten the time of hepatectomy.Multi-mode monitoring such as cerebral oxygen saturation（r SO2）,SVV and SVR can accurately adjust the intraoperative LCVP,making the treatment effect of patients with controlled low central venous pressure safer and more effective.