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The Effect of Low Central Venous Pressure on Intestinal Barrier Function of Patients Undergoing Hepatolobectomy

Author: DaiWeiXin
Tutor: LinChengXin
School: Guangxi Medical University
Course: Anesthesiology
Keywords: Central venous pressure Hepatectomy Cirrhosis Intestinal barrier function
CLC: R614
Type: Master's thesis
Year: 2011
Downloads: 12
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Abstract

Objective: To observe in controlling low central venous pressure (LCVP) downlink lobe resection surgery patients with plasma D-lactate concentration and diamine oxidase activity changes, controlling the LCVP technical line lobe resection perioperative intestinal mucosal barrier function. Methods: 30 cases of elective patients under general anesthesia in the right lobe resection, age 24 to 55 years old, weighing 45 ~ 78kg, ASA Ⅰ or Ⅱ, 8 cases of non-cirrhotic patients with normalized non-cirrhosis LCVP control group. 22 patients with cirrhosis were randomly divided into the cirrhosis the the LCVP group and NCVP the control group, two groups LCVP patients through stringent infusion control, application of small doses of nitroglycerin, diuretic and adjust the position during liver resection CVP regulation 0 to the 4mmHg range of hepatectomy liquid crystal colloids or plasma complement in vivo liquid lack CVP recovery to a level of 5 ~ 10mmHg. NCVP control group CVP is maintained in the range of 5 ~ 10mmHg. All patients bleeding more than 25% of the systemic blood volume or the hemoglobin concentration is less than 80g / l when the start of the infusion and the concentrated red blood cells and plasma. Monitoring of all cases before the induction of anesthesia (T1), after induction (T2), liver parenchymal transection time (T3), the end of surgery (T4), postoperative 24h (T5) and postoperative 48h (T6), MAP and HR. CVP values ??recorded T1 ~ T4 point in time, extract both HB and HCT arterial line monitoring, recording surgery total amount of bleeding and the amount of lost night. T1, T4, T5 and T6 extraction Center venous blood D-LAC DAO concentration was measured. Results: due to surgery, Ⅰ group 1 cases, Ⅱ group 3 patients surgery in need of total hepatic ischemia, so a total of 4 patients excluded from the study observed cases, a total of 26 patients completed the study observed. Bleeding and fluid volume: urine output, fluid volume and blood transfusion volume in the three groups of patients, no statistically significant difference (P gt; 0.05). Compared with group Ⅰ, group Ⅱ, Ⅲ group amount of bleeding was significantly increased (P lt; 0.05); plasma dosage of III group increased significantly. The hemodynamic effects: group Ⅰ and group Ⅲ T2, T3 and T4 in the MAP are significantly lower than T1, T5 and T6 (P lt; 0.05). Ⅱ group at T2 time MAP was significantly lower than the rest of the time points (P lt; 0.05). The group Ⅰ at T6 HR was significantly higher than T1, T2 (P lt; 0.05). The group Ⅱ T3, T5 and T6 time points in the HR were significantly higher than that of T1, T2, T4 (P lt; 0.05). The group Ⅲ T5 and at T6 HR were significantly higher than that of the rest of the time points (P lt; 0.05). Ⅰ group Ⅱ at T4 of CVP was significantly higher than T1, T2, and T3 (P LT; 0.05) T3 points in time, significantly lower than the T2 of CVP. CVP was significantly lower than that of group Ⅲ at T1 T2, T3 and T4 (P lt; 0.05). The comparison between the three groups of patients with MAP and HR groups for each time point were not significantly different (P gt; 0.05). Ⅰ and group Ⅱ T3 CVP CVP was significantly lower than that in group Ⅲ this point in time (P lt; 0.05). HB and HCT: three groups of patients with HB and HCT each time point groups showed no significant difference (P gt; 0.05). Compared with T0, the three groups of patients at T4 HB and HCT were significantly lower (P lt; 0.05). 4 changes of arterial blood gas analysis: Ⅱ group, Ⅲ group T4 PH, BE and the HCO ₃ ^{- significantly lower than T2 (P lt; 0.05). PH, PCO ₂ the PO ₂ the HCO ₃ - the the BE various indicators T2, T4 group showed no significant difference ( P gt; 0.05). Blood D-lactate concentration and DAO _{of live} changes: I, group Ⅱ and group Ⅲ blood concentration of D-lactate and DAO _live of each time point within the group There was no significant difference (P gt; 0.05). I group at each time point of blood D-lactate concentration and the DAO _live and sex were significantly lower than that in group Ⅱ and group Ⅲ (P lt; 0.05). Conclusion: 1. Cirrhosis patients in the lobe resection prior to the presence of intestinal barrier function insufficiency. 2. Controlled low central venous pressure to accept of hepatectomy cirrhotic and non-cirrhotic patients of intestinal barrier function is no significant adverse impact.}

The Effect of Low Central Venous Pressure on Intestinal Barrier Function of Patients Undergoing Hepatolobectomy

Abstract

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