Abstract:

Objective

To investigate the optimal central venous pressure of controlled low central venous pressure （CLCVP） in hepatectomy.

Methods

58 patients undergoing hepatectomy in the Affiliated Hospital of Xuzhou Medical University by the same group of surgeons from January 2020 to January 2023 were enrolled in this study. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were treated with hepatic inflow occlusion combined with CLCVP. The target range of CLCVP was randomly set before surgery. According to the predetermined CVP target，23 patients were divided into group A （4-5 cmH₂O，1 cmH₂O=0.098 kPa），20 cases in group B （2-3 cmH₂O），and 15 cases in group C （0-1 cmH₂O）. Intraoperatively，the CVP was reduced by surgical interventions. If the target CVP was not reached，anesthesia was given to make the CVP reach the predetermined target. Perioperative data were recorded in three groups. The blood loss among three groups was compared by one-way ANOVA，and the rate was compared by Chi-square test.

Results

In group A，22%（5/23） of the patients required surgery combined with anesthesia to control CVP，significantly less than 75%（15/20） in group B and 93%（14/15） in group C （χ²=12.190，18.610； P＜0.05）. In group C，87%（13/15）patients needed fluid replacement and volume expansion to maintain blood pressure stability，significantly higher than 22%（5/23） in group A and 30%（6/20） in group B （χ²=12.850，8.930； P＜0.05）. The average blood loss in group A was （711±280） ml，significantly higher than （491±242） ml in group B and （468±241） ml in group C （LSD-t=2.729，2.755； P＜0.05）.

Conclusions

The optimal CVP of CLCVP should be maintained at 2-3 cmH₂O in hepatectomy，which significantly reduces the amount of bleeding during hepatectomy，exerts slight effect on blood pressure and decreases surgical difficulty.

Key words: Central venous pressure, Hepatectomy, Blood flow occlusion, Intraoperative hemorrhage