Practical effect of dobutamine combined with nitroglycerin in controlled low central venous pressure technique
Objective To explore the practical effect of dobutamine combined with nitroglycerin in controlled low central venous pressure(CLCVP)and its influence on hemodynamics of patients.Methods A total of 50 patients with partial hepatectomy(resection of≥2 liver lobes)were randomly divided into group N(24 cases)and group D(26 cases).From the start of surgery to the completion of hepatectomy and hemostasis,group N used nitroglycerin to maintain central venous pressure(CVP)<5 cm H2O(1 cm H2O=0.098 kPa);group D used dobutamine combined with nitroglycerin to maintain CVP<5 cm H2O.Both groups were compared in terms of surgical conditions[operation time,infusion volume after hepatectomy(T4)and at the end of the surgery(T5),urine volume and intraoperative blood loss],CVP,cardiac index(CI),surgical field grade,hemoglobin(Hb)and hematocrit(HCT)levels,liver and kidney function indicators[alanine aminotransferase(ALT),aspartate transaminase(AST),creatinine(Cr),blood urea nitrogen(BUN)].Results Group D had shorter operation time of(222.8±81.6)min than(277.1±61.3)min in group N;group D had less infusion volume of(2946.1±398.6)ml at T5 and intraoperative blood loss of(223.0±115.5)ml than(3233.5±444.3)and(404.8±219.6)ml in group N(P<0.05).There was no difference in infusion volume at T4 and urine volume between the two groups(P>0.05).Compared with group N,CVP in group D was significantly lower than that in group N at 15 min after surgery(T2)(P<0.05).There was no significant difference in CVP between group D and group N after induction(T1),at the beginning of hepatectomy(T3)and T4(P>0.05).CVP in both groups at T2,T3,and T4 was lower than that at T1(P<0.05),and recovered to near T1 level at T5(P>0.05).CI in group D was significantly higher than that in group N at T3(P<0.05).There was no significant difference in CI between group D and group N at T1,T2,T4 and T5(P>0.05).There was no statistical significance in CI at T1-T4 in group N(P>0.05),but CI at T5 was higher than that at T1(P<0.05).Group D had a higher CI at T2,T3,and T5 compared to T1(P<0.05),while there was no statistically significant difference in CI at T4 compared to T1(P>0.05).The surgical field grade of group D was better than that of group N,with a statistical difference(P<0.05).Group D had higher Hb and HCT at T4 and T5 than those in group N(P<0.05).There were no significant differences in Hb and HCT at T1 between the two groups(P>0.05).Hb and HCT in both groups at T4 and T5 were lower than those at T1(P<0.05).There was no significant difference in ALT,AST,BUN and Cr between the two groups before surgery and on the 1st,3rd and 7th day after surgery(P>0.05).BUN and Cr at 1,3 and 7 days after surgery were not significantly different from that before surgery(P>0.05).ALT and AST in both groups were higher than those before surgery on the 1st and 3rd day after surgery(P<0.05),and there was no significant difference on the 7th day after surgery compared with that before surgery(P>0.05).Conclusion Application of dobutamine combined with nitroglycerin in CLCVP technique can more effectively reduce CVP,maintain circulatory stability and reduce intraoperative blood loss.
Partial hepatectomyDobutamineNitroglycerinControlled low central venous pressure techniqueLow central venous pressure
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