Effects Of Controlled Low Central Venous Pressure On Renal Function Of The Patients Of Hepatic Resection

Objective: To study the effects of low central venous pressure(LCVP) on renal function by observing the changes of the concentration of blood plasma urea nitrogen (BUN), serum creatinine (Scr), serumα₁-microglobulin (α₁-MG), urineα₁-MG on patients of hepatic resection under the LCVP.Method: Thirty ASAâ… -â…¡patients with right liver tumor who will be on hepatectomy under general anesthesia were divided into two groups randomly, fifteen patients of each: LCVP (groupâ… ); Control (groupâ…¡). In groupâ… ,CVP was controlled in the range from > 0 to≤5cmH₂O by limiting the infusion of fluid strictly and/or using low-dose nitroglycerin. In each group, CVP was controlled in the range from>5 to≤12cmH₂O. SBP, DBP, MAP, HR and CVP were monitored and recorded at just before intubation(t₁), the starting of hepatic resection(t₂), the end of hepatic resection(t₃) and closing abdominal cavity(t₄). The volume of blood loss, transfusion and urine and the lasting time of LCVP and surgery were recorded. At five different time point: the first morning after entering the hospital(T₀),the time of closing abdominal cavity(T₁), 24 hours after operation(T₂), 72 hours after operation(T₃) and 120 hours after operation(T₄), the 5ml blood samples were drawn from peripheral vein, the 10ml urine was preserved, then, the concentration of BUN, Scr, serumα₁-MG and urineα₁-MG were evaluated.Results:1. Compared groupâ…¡,the volume of the infusion of fluid, the volume of blood loss and urine of groupâ… in operation decreased(P < 0.05). 2. The effect of LCVP on haemodynamics: (1) Comparison in groupâ… : Compared t₁ and t₄,SBP decreased at t₂ and t₃ (P < 0.05); Compared t₁, DBP decreased at t₃(P < 0.05); Compared t₁, MAP decreased at t₂ and t₃(P < 0.05), compared t₄, MAP decreased at t₃(P < 0.05); Compared t₁ and t₄ ,HR increased at t₂ and t₃(P < 0.05); Compared t₁ and t₄, CVP decreased at t₂ and t₃(P < 0.05), compared t₄, CVP decreased at t₁(P < 0.05). (2) Comparison in groupâ…¡: Compared t₁ and t₂, SBP and DBP decreased at t₃ and t₄(P < 0.05); Compared t₁ and t₂, MAP decreased at t₃ (P < 0.05), compared t₂, MAP decreased at t₄(P < 0.05); Compared t₁ and t₃,CVP increased at t₂ and t₄(P < 0.05), compared t₂, CVP increased at t₄(P < 0.05). (3) Comparison of each group: Compared groupâ…¡, SBP of groupâ… decreased at t₂(P < 0.05); HR of groupâ… increased at t₂ and t₃(P < 0.05); CVP of groupâ… decreased at t₂,t₃ and t₄(P < 0.05). (4)All of SBP, DBP, MAP, HR and CVP were in normal scope. 3. The effect of LCVP on renal function: (1) Comparison in groupâ… : the concentration of BUN, Scr and urineα₁-MG of every time point had no conspicuous difference (P > 0.05), compared T₀, the concentration of serumα₁-MG decreased at T₁, T₂, T₃ and T₄(P < 0.05), compared T₁, the concentration of serumα₁-MG decreased at T₂ and T₃(P < 0.05). (2) Comparison in groupâ…¡: the concentration of BUN, Scr and urineα₁-MG of every time point had no conspicuous difference, compared T₀, the concentration of serumα₁-MG decreased at T₁ T₂, T₃ and T₄(P < 0.05). (3) Comparison of each group: Compared groupâ…¡, the concentration of urineα₁-MG of groupâ… decreased at T₂(P < 0.05).Conclusion: Our study suggests that controlled LCVP may decrease the volume of blood loss in hepatectomy ; controlled LCVP has no significant adverse effects on human haemodynamics and renal function , compared the traditional method, controlled LCVP may has positive effects on operative renal function of the patients of hepatic resection.