Application Effect of Controlled Low Central Venous Pressure in Laparoscopic Hepatectomy

WANG Gang; GUO Ke; ZHANG Bo; LIU Qiuhua; ZHU Zhencheng

doi:10.14033/j.cnki.cfmr.2025.02.008

Abstract：Objective:To investigate the application effect of controlled low central venous pressure(CLCVP)in laparoscopic hepatectomy.Method:Seventy patients undergoing hepatectomy admitted to Zhangjiagang First People's Hospital from January 2018 to December 2023 were retrospectively selected.According to different treatment methods,they were divided into control group(38 cases)and observation group(32 cases).The control group was treated with conventional open hepatectomy,and the observation group was treated with laparoscopic hepatectomy.CLCVP was performed in both groups.Stress indexes,hemodynamic indexes,cerebral metabolism indexes before anesthesia(T0),10 min after surgery(T1),30 min after surgery(T2),surgery completed(T3),and hepatic function indexes before surgery and 1 week after surgery between the two groups were compared.Result:At T1,T2,and T3,the levels of cortisol(Cor),norepinephrine(NE),epinephrine(E)and adrenal hormone(DA)in two groups were increased compared with those at T0,the levels of Cor,NE,E and DA in the observation group were lower than those in the control group,and the differences were statistically significant(P＜0.05);the heart rate(HR)and mean arterial pressure(MAP)at T1,T2 and T3 in two groups were higher than those at T0,the systolic blood pressure(SBP)and diastolic blood pressure(DBP)at T1,T2 in two groups and at T3 in the observation group were lower than those at T0,the SBP and DBP at T3 in the control group were higher than those at T0,the HR,MAP,SBP and DBP in the observation group were lower than those in the control group,and the differences were statistically significant(P＜0.05);at T1 and T2,the levels of jugular venous oxygen saturation(SjvO2)in two groups were lower than those at T0,and the levels of SjvO2 in the observation group at T1,T2 and T3 were higher than those in the control group,at T1,T2 and T3,the levels of lactic acid(LA)and blood glucose(Glu)in two groups were higher than those at T0,but the levels of LA and Glu in the observation group were lower than those in the control group,and the differences were statistically significant(P＜0.05);at 1 week after operation,the levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in two groups were lower than those before operation,and the levels of ALT and AST in the observation group were lower than those in the control group,the differences were statistically significant(P＜0.05).Conclusion:Compared with CLCVP during conventional open hepatectomy,CLCVP during laparoscopic hepatectomy can help reduce the stress response of patients,maintain the stability of hemodynamics and brain metabolism,and also improve the recovery effect of liver function after surgery.