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Effects of Low Central Venous Pressure during Preanhepatic Phase on Blood Loss,Liver and Renal Function in Liver Tansplantation

冯智英  徐晓  祝胜美  郑树森  
【摘要】:Background Although low central venous pressure (LCVP) technique is used to decrease blood loss during liver resection,its efficacy and safety during transplant procedures are still debatable. Our study aimed at assessing the effects of this technique and its clinical safety for recipients undergoing liver transplantations. Methods Eighty-six adult patients were randomly divided into a LCVP and a control group respectively. In the LCVP group,CVP was maintained below 5 mmHg or 40 % lower than baseline during the preanhepatic phase by limiting infusion volume,manipulating the patient's posture as well as administration of somatostatin and nitroglycerine. Recipients in the control group received standard care. Hemodynamics,blood loss,liver function and renal function were compared perioperatively between the two groups. Results A lower CVP was maintained in the LCVP group during the preanhepatic phase,resulting in a significant decrease in blood loss (1922±1429 mL vs. 3111±1833v mL,P0.05) and transfusion volume (1200±800 mL vs.2400±1200 mL,P0.05) intraoperatively. Compared with the control group,LCVP group showed a significant lower mean arterial pressure at 2 h after operation beginning (74±11 mmHg vs. 84±14 mmHg,P0.05),a lower lactate value at the end of operation (5.9±3.0 mmol/L vs. 7.2±3.0 mmol/L,P0.05),and a better preservation of liver function after the declamping of the portal vein. There were no significant differences in perioperative renal function and postoperative complications. Conclusions The LCVP technique during the preanhepatic phase reduced intraoperative blood loss,protected liver function,and had no detrimental effects on renal function in LT.

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