Comparison of acute normovolemic hemodilution in patients undergoing lobectomy under controlled low central venous pressure

ZHONG Wanmei; YE Zeming; YANG Shideng; OU Wei; HE Lilong

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Journal of Hunan Normal University(Medical Science) ›› 2023, Vol. 20 ›› Issue (5) : 90-94.

Comparison of acute normovolemic hemodilution in patients undergoing lobectomy under controlled low central venous pressure

ZHONG Wanmei, YE Zeming, YANG Shideng, OU Wei, HE Lilong

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Abstract

Objective To explore the value of acute isovolume hemodilution in patients with hepatic lobectomy under controlled low central venous pressure. Methods Thirty 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. Results The 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 jvO₂ and SjvO₂ at each time point;The measured value of CERO₂ in 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. Conclusion The 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.

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acute normovolemic hemodilution / controlled low central venous pressure / lobectomy of liver / hemodynamics

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ZHONG Wanmei, YE Zeming, YANG Shideng, OU Wei, HE Lilong. Comparison of acute normovolemic hemodilution in patients undergoing lobectomy under controlled low central venous pressure[J]. Journal of Hunan Normal University(Medical Science). 2023, 20(5): 90-94

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