Abstract：ObjectiveTo explore the value of acute isovolume hemodilution in patients with hepatic lobectomy under controlled low central venous pressure.MethodsThirty patients with selective hepatectomy who were admitted to Wuzhou People’s Hospital from August 2020 to August 2022 were selected and divided into the test group（using acute normovolemic hemodilution combined with controlled low central venous pressure）and the control group（using controlled low central venous pressure）with 15 patients each using a random number table. Compare the hemodynamic indexes,cerebral oxygen metabolism indexes,coagulation function indexes,quality of awakening period Incidence of adverse reaction of anesthesia.ResultsThe central venous pressure（CVP）,mean arterial pressure（MAP）,and heart rate（HR）of patients were compared between the test group and the control group at four different time points：before blood dilution,before hepatic portal occlusion,during hepatectomy,and upon completion of the surgery. There was no significant difference between the two groups;The Hct values of patients in the test group were significantly lower than those in the control group before hepatic portal occlusion and at the time of hepatectomy;There was no significant difference between the two groups in the measured values of Da jvO2and SjvO2at each time point;The measured value of CERO2in the test group was significantly lower than that in the control group before hepatic portal occlusion,and the measured value of VADL in the test group before hepatic portal occlusion and during hepatectomy was significantly lower than that in the control group;Before hemodilution,the measured values of PT,APTT,Fib and TT in the two groups showed no significant difference;The measured values of PT and APTT in the test group were significantly lower than those in the control group after operation;There was no significant difference between the test group and the control group in the time of opening eyes,extubation and leaving the recovery room;The incidence of anesthesia related adverse reactions in the test group was 26.67%,compared with 60.00% in the control group,and there was no significant difference.ConclusionThe application of acute normovolemic hemodilution combined with controlled low central venous pressure in hepatectomy under general anesthesia is conducive to stabilizing the hemodynamic indexes of patients,maintaining the balance between cerebral oxygen supply and demand,and reducing the impact of surgery on the coagulation function of patients.
[1] Liu TS,Shen QH,Zhou XY,et al.Application of controlled low central venous pressure during hepatectomy:A systematic review and meta-analysis[J]. J Clin Anesth,2021,75(12):110467. [2] Park L,Gilbert R,Baker L,et al.The safety and efficacy of hypovolemic phlebotomy on blood loss and transfusion in liver surgery:a systematic review and meta-analysis[J]. HPB(Oxford),2020,22(3):340-350. [3] Ninh KV,Nguyen NQ,Trinh SH,et al.The application of selective hepatic inflow vascular occlusion with anterior approach in liver resection:effectiveness in managing major complications and long-term survival[J]. Int J Hepatol,2021,2021(4):6648663. [4] Wang F,Sun D,Zhang N,et al.The efficacy and safety of controlled low central venous pressure for liver resection:a systematic review and meta-analysis[J]. Gland Surg,2020,9(2):311-320. [5] Liu TS,Shen QH,Zhou XY,et al.Application of controlled low central venous pressure during hepatectomy:A systematic review and meta-analysis[J]. J Clin Anesth,2021,75(12):110467. [6] Hendrickson JE,Roubinian NH,Chowdhury D,et al.Recipient Epidemiology and Donor Evaluation Study(REDS-III)Incidence of transfusion reactions:a multi-center study utilizing systematic active surveillance and expert adjudication[J]. Transfusion,2016,56(10):2587-2596. [7] Remy KE,Hall MW,Cholette J,et al.Mechanisms of red blood cell transfusion-related immunomodulation[J]. Transfusion,2018,58(3):804-815. [8] Okuno T,Kunisawa S,Fushimi K,et al.Intra-operative autologous blood donation for cardiovascular surgeries in Japan:a retrospective cohort study[J]. PLoS One,2021,16(3):e0247282. [9] Takekawa D,Saito J,Kinoshita H,et al.Acute normovolemic hemodilution reduced allogeneic blood transfusion without increasing perioperative complications in patients undergoing free-flap reconstruction of the head and neck[J]. J Anesth,2020,34(2):187-194. [10] Barile L,Fominskiy E,Di Tomasso N,et al.Acute normovolemic hemodilution reduces allogeneic blood cell transfusion in cardiac surgery:a systematic review and meta-analysis of randomized trials[J]. Anesth Analg,2017,124(3):743-752. [11] Takekawa D,Saito J,Kinoshita H,et al.Acute normovolemic hemodilution reduced allogeneic blood transfusion without increasing perioperative complications in patients undergoing free-flap reconstruction of the head and neck[J]. J Anesth,2020,34(2):187-194. [12] Murata Y,Kusudo E,Kawamoto S,et al.Effects of whole blood storage in a polyolefin blood bag on platelets for acute normovolemic hemodilution[J]. Sci Rep,2021,11(1):12201. [13] Roberts N,James S,Delaney M,et al.The global need and availability of blood products:A modelling study[J]. Lancet Haematol,2019,6(12):e606-e615. [14] Li Y,Zhang Y,Fang X.Acute normovolemic hemodilution in combination with tranexamic acid is an effective strategy for blood management in lumbar spinal fusion surgery[J]. J Orthop Surg Res,2022,17(1):71-75. [15] Batista MFS,Costa CO,Vialle EN,et al.Acute normovolemic hemodilution in spinal deformity surgery[J]. Rev Bras Ortop(Sao Paulo),2019,54(5):516-523. [16] Vassiliou I,Arkadopoulos N,Stafyla V,et al.The introduction of a simple maneuver to reduce the risk of postoperative bleeding after major hepatectomies[J]. J Hepatobiliary Pancreat Surg,2009,16(4):552-556. [17] 赵玉潮. 麻醉意外、并发症的区别[J]. 人人健康,2020(14):22. [18] Meng L,Yu W,Wang T,et al.Blood pressure targets in perioperative care[J]. Hypertension,2018,72(4):806-817. [19] Fan X,Lin L,Li G,et al.Do cerebral and somatic tissue oxygen saturation measurements correlate with each other during surgery?[J]. J Clin Monit Comput,2020,34(3):483-490. [20] 张艳杰,解永强,赵顺来,等. 急性高容量血液稀释联合控制性降压对全髋关节置换患者异体输血和脑氧代谢的影响[J]. 临床血液学杂志,2017,30(12):944-947. [21] 徐霞,胡礼宏,方向明. 急性高容量血液稀释对腹腔镜前列腺癌根治术患者脑氧代谢的影响[J]. 中国输血杂志,2018,31(4):387-390. [22] 周峻豪,曾广吾,李炎梅,等. 血液输注对围手术期患者凝血功能的影响分析[J]. 中国实用医药,2022,17(22):53-55. [23] Kinoshita H,Saito J,Nakai K,et al.Clotting functional stability of withdrawing blood in storage for acute normovolemic hemodilution:a pilot study[J]. J Anesth,2021,35(1):35-42. [24] 高广艳,赵敬东. 自体血回输对髋关节置换术患者凝血功能及炎症因子的影响[J]. 菏泽医学专科学校学报,2022,34(3):20-22+26.
2023,Vol. 20
