The Application Of Controlled Low Central Venous Pressure In Hilar Cholangiocarcinoma Operation

Objective To investigate the influences of controlled low central venous pressure（CLCVP）used in the operation of hilar cholangiocarcinoma on hemodynamics and internalenvironment, evaluating the radical feasibility and safety of CLCVP in the operation ofhilar cholangiocarcinoma.Methods60patients undergoing radical resection of hilar cholangiocarcinoma and60cases of patients undergoing liver ectomy in the PLA General Hospital were enclosed inthis study. According to whether the use of controlled low central venous pressure,theyare respectively divided into four groups with jaundice: controlled low central venouspressure group (group A), jaundice group without controlled low central venouspressure (group B), controlled low central venous pressure group undergoing liveroperation(group C), the group undergoing liver operation without controlled lowcentral venous pressure (group D). The CVP of group A and C was controlled <5mmHg by limiting the liquid infusion, adjust the head position (high10-15°) andisoflurane inhalation or infusion of nitroglycerine0.1-2μ g/(kg·min); The CVP ofgroupB and D was in5-12mmHg. Recording index of heart rate(HR), mean arterialpressure(MAP), cardiac output (CO), central vein pressure (CVP), strokevolume(SV), stroke volume variation(SVV),stroke volume index(SVI)at theoperation beginning(T1), after hemostasis excision (T2), after abdominalclosure(T3),;Did the arterial blood gas analysis and recording PH, Lac, SaO2, PaO2atthe same time. Record the bleeding volume, preoperative and postoperative24h ureanitrogen and creatinine values.Results:(1) The CVP, SV, SVI of group A was lower than that in the group B at T2,SVV of group A was higher than the group B at T2(p<0.05); while The CVP,SVV ofgroup C was lower than that in the group D, SVV of group C was higher than that in the group D at T2(p<0.05);(2) Compared with T1, PH、BE、 Lac of each group at T2,T3were significant difference (P<0.05); there was no difference among the blood gasparameters of the four groups at each time point (P>0.05);(3) The bleeding volume andthe amount of blood transfusion of group A was less than that in group B (p<0.05), thebleeding volume and the amount of blood transfusion of group A was less than that ofgroup B (p<0.05);(4) The application of vasoactive drugs of group was more than thegroup C(p<0.05), The application of vasoactive drugs of group C was more than thegroup D(p<0.05), the dosage of vasoactive drugs in jaundice group was more than thegroup without jaundice (p<0.05);there is a linear relationship between the total bilirubinof blood and the dosage of vasoactive drugs.(5) There was no significant differencebetween before and after operation24hours, serum creatinine, urea nitrogen values infour groups of patients (p>0.05).Conclusion The controlled low central venous pressure used in the operation of hilarcholangiocarcinoma can significantly reduce the bleeding during operation,theenvironment and renal function had no obvious changes.The intraoperativehemodynamics of patients with jaunce has an obvios change,they need applingvasoactive drugs to regulate.