Low central venous pressure reduces blood loss in hepatectomy.
OBJECTIVE
To investigate the effect of low central venous pressure (LCVP) on blood loss during hepatectomy for hepatocellular carcinoma (HCC).


METHODS
By the method of sealed envelope, 50 HCC patients were randomized into LCVP group (n=25) and control group (n=25). In LCVP group, CVP was maintained at 2-4 mmHg and systolic blood pressure (SBP) above 90 mmHg by manipulation of the patient's posture and administration of drugs during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. The patients' preoperative conditions, volume of blood loss during hepatectomy, volume of blood transfusion, length of hospital stay, changes in hepatic and renal functions were compared between the two groups.


RESULTS
There were no significant differences in patients' preoperative conditions, maximal tumor dimension, pattern of hepatectomy, duration of vascular occlusion, operation time, weight of resected liver tissues, incidence of post-operative complications, hepatic and renal functions between the two groups. LCVP group had a markedly lower volume of total intraoperative blood loss and blood loss during hepatectomy than the control group, being 903.9+/-180.8 mL vs 2 329.4+/-2 538.4 (W=495.5, P<0.01) and 672.4+/-429.9 mL vs 1 662.6+/-1 932.1 (W=543.5, P<0.01). There were no remarkable differences in the pre-resection and post-resection blood losses between the two groups. The length of hospital stay was significantly shortened in LCVP group as compared with the control group, being 16.3+/-6.8 d vs 21.5+/-8.6 d (W=532.5, P<0.05).


CONCLUSIONS
LCVP is easily achievable in technique. Maintenance of CVP<or= 4 mmHg can help reduce blood loss during hepatectomy, shorten the length of hospital stay, and has no detrimental effects on hepatic or renal function.
Wang
Wei-Dong
WD
Department of General Surgery, The First People's Hospital of Shun De, and Sun Yat-Sen University, Guangdong Province, China.
Liang
Li-Jian
LJ
Huang
Xiong-Qing
XQ
Yin
Xiao-Yu
XY
D000328:Adult; D016063:Blood Loss, Surgical / Q000503:physiopathology*; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D007430:Intraoperative Care; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies