[The hemodynamics during hemodilution and its influence on the liver functions after hepatectomy for hepatocellular carcinoma with liver cirrhosis].
The hemodynamics during hemodilution occurred after hepatectomy for hepatocellular carcinoma with liver cirrhosis and its influences on the liver functions were studied. The hematocrit value gradually decreased about 10% until the 4th postoperative day owing to hemodilution after hepatectomy. While anemia progressed, cardiac index inversely increased. Under such a condition, oxygen consumption was maintained so that acidosis did not develop. Arterial blood ketone body ratio was also kept within a normal range except for a case whose hematocrit value decreased to 17.1%. Although the escaped hepatic enzymes such as GOT and GPT increased in the serum after hepatectomy, hemodilution was not responsible for their increase. While total bilirubin increased in the severe hemodiluted group, the increase was not due to hemodilution but caused by blood transfusion. The protein synthesis of the liver measured by rapid turnover protein levels in plasma was depressed after surgery, and this depression prolonged to the 14th postoperative day in the group whose hematocrit value decreased below 20%. These results suggest that it is better to keep hemodynamics without blood transfusion unless the hematocrit value decrease below 20%, and also better to maintain the hematocrit above 20% for liver regeneration after hepatectomy.
Ishiyama
S
S
First Department of Surgery, Yamagata University School of Medicine, Japan.
Seo
N
N
Iizawa
H
H
Fuse
A
A
Sato
K
K
Adachi
K
K
Tsukamoto
M
M
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006400:Hematocrit; D006438:Hemodilution; D006439:Hemodynamics; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged