Safety and effectiveness of different levels of controlled low central venous pressure in patients undergoing laparoscopic liver resection
Objective To explore the safety and efficacy of different levels of controlled low central venous pressure(CLCVP)in pa-tients undergoing laparoscopic hepatectomy(LH),and to provide reference for the reasonable application of CLCVP in hepatobiliary surgery.Methods A total of 137 patients with concurrent LH were selected from the Seventh Medical Center of Chinese PLA General Hospital from January 2020 to December 2022.Patients were divided into 3 groups according to whether CLCVP technique was used and the level of CLCVP.Group A(n =43)received Pringle method without CLCVP technique.Group B(n =48)underwent Pringle method combined with CLCVP technology,and the central venous pressure(CVP)was 1-2 cmH2 O.Group C(n =46)underwent Pringle method combined with CLCVP technology,and the CVP was 3-5 cmH2 O.The time of liver resection,blood loss,urine volume and total infusion volume of the 3 groups were compared.Blood gas analysis indexes[arterial oxygen saturation(SaO2),bicarbonate(HCO-3),alkali residual(BE)]and liver and kidney function indexes[alanine transaminase(ALT),aspartate aminotransferase(AST),blood u-rea nitrogen(BUN),creatinine(Cr)]before and 1 and 3 days after surgery of the 3 groups were compared.Results The liver resec-tion time,blood loss,urine volume and total infusion volume in group B and group C were significantly lower than those in group A,and the differences were statistically significant(P＜0.05).There was no significant difference in SaO2 among 3 groups before surgery and 1 and 3 days after surgery(P＞0.05).Before surgery,there was no significant difference in HCO-3 and BE levels among3 groups(P＞0.05).The levels of HCO-3 and BE in group C were significantly higher than those in group A and group B on the 1st and3rd day af-ter surgery,with statistical significance(P＜0.05).Before surgery,there were no significant differences in AST,ALT,BUN and Cr lev-els among 3 groups(P＞0.05).On the 1st and 3rd day after operation,there were no significant differences in BUN and Cr levels a-mong the 3 groups(P＞0.05).The levels of ALT and AST in group C were lower than those in group A and group B on the 1st and 3rd day after operation,and the difference was statistically significant(P＜0.05).Conclusion CLCVP technology can reduce the a-mount of blood loss during LH operation and shorten the operation time,and does not affect the blood oxygen saturation and kidney function of patients,and has a good safety.When CLCVP is controlled at 3-5 cmH2 O,it has little effect on the liver function and acid-base balance of patients,and the postoperative recovery is faster,and the acid-base metabolic balance in vivo can be better maintained.
Controlled low central venous pressureLaparoscopic hepatectomyClinical efficacySafety
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