Effects of controlled low central venous pressure combined with target-directed fluid therapy on bleeding and myocardial,intestinal,and renal damage in patients undergoing hepatectomy
Objective To explore the effects of controlled low central venous pressure(LCVP)combined with target-directed fluid therapy on bleeding and myocardial,intestinal,and renal damage in patients undergoing hepatectomy.Methods Seventy patients who underwent laparoscopic hepatectomy from April 2023 to April 2024 at our hospital were selected as the study subjects and were divided into two groups of 35 each using the random number table method:the control group(conventional fluid replacement)and the observation group(controlled low central venous pressure combined with target-directed fluid therapy).The operation time,intraoperative blood loss,hepatic hilum occlusion time,and fluid infusion volume were compared between the two groups.Heart rate(HR),mean arterial pressure(MAP),and lactate(Lac)levels at entry to the operating room(T0),10 minutes before hepatectomy(T1),10 minutes after hepatectomy(T2),and 5 minutes before the end of surgery(T3)were recorded.Preoperative and postoperative levels of alanine aminotransferase(AST),aspartate aminotransferase(ALT),total bilirubin(TBIL),troponin T(TnT),intestinal fatty acid-binding protein(I-FABP),and creatinine(Scr)were assessed,along with the incidence of postoperative myocardial injury,intestinal injury,and acute kidney injury.Results The observation group had significantly lower operation time,intraoperative blood loss,hepatic hilum occlusion time,and fluid infusion volume compared to the control group(P<0.05).At T1,the HR in the observation group was lower than in the control group,and at T1,T2,and T3,the MAP in the observation group was lower than in the control group.At T1 and T2,Lac in the observation group was higher than in the control group,with statistically significant differences(P<0.05).Preoperative levels of AST,ALT,TBIL,TnT,I-FABP,and Scr showed no significant difference between the two groups(P>0.05).Postoperatively,these levels were significantly lower in the observation group than in the control group(P<0.05).The incidence of myocardial injury(5.71%),intestinal injury(17.14%),and acute kidney injury(11.43%)in the observation group was lower than in the control group(22.86%,40%,31.41%),with statistically significant differences(P<0.05).Conclusions The application of LCVP combined with target-directed fluid therapy in hepatectomy can help maintain the stability of intraoperative hemodynamic indices,reduce intraoperative blood loss,decrease the surgical impact on the patient's myocardium,intestines,and kidneys,and aid in postoperative recovery.
HepatectomyControlled low central venous pressureTarget-oriented fluid management
万方数据
维普
