Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma
Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma
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DOI：
10.1016/s1499-3872(13)60082-x
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发表时间：
2013-10-15
影响因子：
3.3
通讯作者：
Lai, Eric C. H.
中科院分区：
文献类型：
--
作者：
Lin, Cheng-Xin;Guo, Ya;Lai, Eric C. H.
背景：低中心静脉压（CVP）影响血流动力学稳定性和组织灌注。本前瞻性研究旨在评价肝细胞癌（HCC）行肝部分切除术时的最佳CVP。方法：97例HCC行肝部分切除术的患者，肝实质横断时CVP控制在0 ~ 5 mmHg。如果可能，将收缩压（SBP）维持在90 mmHg或更高。B型肝炎表面抗原阳性90例（92.8%），肝硬化84例（86.6%）。在这些患者中常规使用Pringle手法，夹闭/松开周期为15/5分钟。平均钳夹时间为21.4 ± 8.0分钟。根据中心静脉压分为5组：A组：0-1 mmHg; B组：1.1 ~ 2 mmHg; C组：2.1 ~ 3 mmHg; D组：3.1 ~ 4 mmHg; E组：4.1 ~ 5 mmHg。结果：在主动液体负荷下，A组有18.6%的患者维持最佳SBP ≥ 90 mmHg，而B组无一例出现SBP ≥ 90 mmHg的情况（95% CI：10.8%-26.3%）; B组为39.2%（95% CI：29.5%-48.9%）; C组72.2%（95% CI：63.2%-81.1%）; D组89.7%（95% CI：83.6%-95.7%）; E组100%（95% CI：100%-100%）。肝实质横断时单位横断面积的失血量随着CVP的降低而降低。A、B、C组失血量明显少于D、E组（方差分析，P
BACKGROUND: Low central venous pressure (CVP) affects hemodynamic stability and tissue perfusion. This prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma (HCC).METHODS: Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal transection. The systolic blood pressure (SBP) was maintained, if possible, at 90 mmHg or higher. Hepatitis B surface antigen was positive in 90 patients (92.8%) and cirrhosis in 84 Patients (86.6%). Pringle maneuver was used routinely in these patients with clamp/undamp cycles of 15/5 minutes. The average clamp time was 21.4+/-8.0 minutes. These patients were divided into 5 groups based on the CVP: group A: 0-1 mmHg; B: 1.1-2 mmHg; C: 2.1-3 mmHg; D: 3.1-4 mmHg and E: 4.1-5 mmHg. The blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were analyzed.RESULTS: With active fluid load, a constant SBP >= 90 mmHg which was considered as optimal was maintained in 18.6% in group A (95% CI: 10.8%-26.3%); 39.2% in group B (95% CI: 29.5%-48.9%); 72.2% in group C (95% CI: 63.2%-81.1%); 89.7% in group D (95% CI: 83.6%-95.7%); and 100% in group E (95% CI: 100%-100%). The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in CVP. Compared to groups D and E, blood loss in groups A, B and C was significantly less (analysis of variance test, P