控制性低中心静脉压在肝切除术中的应用进展_West China Medical Journal

Authors：

 杨淑婷 ,  刘斌

四川大学华西医院麻醉科 (成都 610041);

Corresponding author：

刘斌, Email: liubinhx@foxmail.com

Keywords：

肝切除术; 低中心静脉压; 麻醉; 肝脏

DOI：

10.7507/1002-0179.201600215

Video：

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Abstract Full text Figures/Tables Video References Cited by

大量出血和输血是肝切除术患者发生并发症和病死率增高的高危因素。控制性低中心静脉压技术有助于减少肝切除术中出血量和输血量，缩短术后住院时间，提高存活率。现有研究表明适当使用控制性低中心静脉压技术对全身心脑肾等重要脏器功能无明显影响，但尚需更多大样本多中心临床前瞻性研究证实。

Citation： 杨淑婷, 刘斌. 控制性低中心静脉压在肝切除术中的应用进展. West China Medical Journal, 2016, 31(4): 789-793. doi: 10.7507/1002-0179.201600215 Copy

1.	Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade[J]. Ann Surg, 2002, 236(4): 397-406.
2.	Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma[J]. Ann Surg, 2009, 249(4): 617-623.
3.	Stephenson KR, Steinberg SM, Hughes KS, et al. Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases[J]. Ann Surg, 1988, 208(6): 679-687.
4.	Kooby DA, Stockman J, Ben-Porat L, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases[J]. Ann Surg, 2003, 237(6): 860-869.
5.	Poon RT. Current techniques of liver ransaction[J]. HPB (Oxford), 2007, 9(3): 166-173.
6.	Fan ST, Mau Lo C, Poon RT, et al. Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience[J]. Ann Surg, 2011, 253(4): 745-758.
7.	冯龙, 冯泽国, 蔡守旺, 等. 控制性低中心静脉压技术在精准肝切除术中的应用[J]. 军医进修学院学报, 2012, 18(5): 482-484.
8.	Bui LL, Smith AJ, Bercovici M, et al. Minimising blood loss and transfusion requirements in hepatic resection[J]. HPB (Oxford), 2002, 4(1): 5-10.
9.	Choukèr A, Schachtner T, Schauer R, et al. Effects of pringle manoeuvre and ischaemic preconditioning on haemodynamic stability in patients undergoing elective hepatectomy: a randomized trial[J]. Br J Anaesth, 2004, 93(2): 204-211.
10.	Koea JB, Batiller J, Patel B, et al. A phase Ⅲ, randomized, controlled, superiority trial evaluating the fibrin pad versus standard of care in controlling parenchymal bleeding during elective hepatic surgery[J]. HPB (Oxford), 2013, 15(1): 61-70.
11.	Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effects on blood loss during liver resection[J]. Br J Surg, 1998, 85(8): 1058-1060.
12.	Melendez JA, Arslan V, Fischer ME, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction[J]. J Am Coll Surg, 1998, 187(6): 620-625.
13.	Smyrniotis V, Kostopanagiotou G, Theodoraki K, et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections[J]. Am J Surg, 2004, 187(3): 398-402.
14.	Wang WD, Liang LJ, Huang XQ, et al. Low central venous pressure reduces blood loss in hepatectomy[J]. World J Gastroenterol, 2006, 12(6): 935-939.
15.	Li Z, Sun YM, Wu FX, et al. Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy[J]. World J Gastroenterol, 2014, 20(1): 303-309.
16.	Kambakamba P, Slankamenac K, Tschuor C, et al. Epidural analgesia and perioperative kidney function after major liver resection[J]. Br J Surg, 2015, 102(7): 805-812.
17.	De Hert SG, Preckel B, Schlack WS. Update on inhalational anaesthetics[J]. Curr Opin Anaesthesiol, 2009, 22(4): 491-495.
18.	Soonawalla ZF, Stratopoulos C, Stoneham M, et al. Role of the reverse-Trendelenberg patient position in maintaining low-CVP anaesthesia during liver resections[J]. Langenbecks Arch Surg, 2008, 393(2): 195-198.
19.	Hasegawa K, Takayama T, Orii R, et al. Effect of hypoventilation on bleeding during hepatic resection: a randomized controlled trial[J]. Arch Surg, 2002, 137(3): 311-315.
20.	Feng ZY, Xu X, Zhu SM, et al. Effects of low central venous pressure during preanhepatic phase on blood loss and liver and renal function in liver transplantation[J]. World J Surg, 2010, 34(8): 1864-1873.
21.	Jarnagin WR, Gonen M, Maithel SK, et al. A prospective randomized trial of acute normovolemic hemodilution compared to standard intraoperative management in patients undergoing major hepatic resection[J]. Ann Surg, 2008, 248(3): 360-369.
22.	Yoneda G, Katagiri S, Yamamoto M. Reverse trendelenburg position is a safer technique for lowering central venous pressure without decreasing blood pressure than clamping of the inferior vena cava below the liver[J]. J Hepatobiliary Pancreat Sci, 2015, 22(6): 463-466.
23.	Rahbari NN, Koch M, Zimmermann JB, et al. Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial[J]. Ann Surg, 2011, 253(6): 1102-1110.
24.	Zhu P, Lau WY, Chen YF, et al. Randomized clinical trial comparing infrahepatic inferior vena cava clamping with low central venous pressure in complex liver resections involving the Pringle manoeuvre[J]. Br J Surg, 2012, 99(6): 781-788.
25.	Kato M, Kubota K, Kita J, et al. Effect of infra-hepatic inferior vena cava clamping on bleeding during hepatic dissection: a prospective, randomized, controlled study[J]. World J Surg, 2008, 32: 1082-1087.
26.	Moulton CA, Chui AK, Mann D, et al. Does patient position during liver surgery influence the risk of venous air embolism?[J]. Am J Surg, 2001, 181(4): 366-367.
27.	Sand L, Rizell M, Houltz E, et al. Effect of patient position and PEEP on hepatic, portal and central venous pressures during liver resection[J]. Acta Anaesthesiol Scand, 2011, 55(9): 1106-1112.
28.	Guo Y, Lin CX, Lau WY, et al. Hemodynamics and oxygen transport dynamics during hepatic resection at different central venous pressures in a pig model[J]. Hepatobiliary Pancreat Dis Int, 2011, 10(5): 516-520.
29.	黄婵燕, 华赟鹏, 邬艳, 等. 控制性低中心静脉压对右半肝切除术患者术后重要脏器功能的影响[J]. 中华普通外科学文献: 电子版, 2013, 7(1): 30-35.
30.	Barton JS, Riha GM, Differding JA, et al. Coagulopathy after a liver resection: is it over diagnosed and over treated?[J]. HPB (Oxford), 2013, 15(11): 865-871.
31.	Guo JR, Shen HC, Liu Y, et al. Effect of acute normovolemic hemodilution combined with controlled low central venous pressure on cerebral oxygen metabolism of patients with hepalobectomy[J]. Hepatogastroenterology, 2015, 61(136): 2321-2325.
32.	Yigitler C, Farges O, Kianmanesh R, et al. The small remnant liver after major liver resection: how common and how relevant?[J]. Liver Transpl, 2003, 9(9): S18-S25.
33.	Moug SJ, Smith D, Wilson IS, et al. The renal sequelae of a novel triphasic approach to blood loss reduction during hepatic resection[J]. Eur J Surg Oncol, 2006, 32(4): 435-438.
34.	Armstrong T, Welsh FK, Wells J, et al. The impact of pre-operative serum creatinine on short-term outcomes after liver resection[J]. HPB (Oxford), 2009, 11(8): 622-628.
35.	Correa-Gallego C, Berman A, Denis SC, et al. Renal function after low central venous pressure-assisted liver resection: assessment of 2116 cases[J]. HPB (Oxford), 2015, 17(3): 258-264.
36.	Squires MH, Lad NL, Fisher SB, et al. The effect of preoperative renal insufficiency on postoperative outcomes after major hepatectomy: a multi-institutional analysis of 1,170 patients[J]. J Am Coll Surg, 2014, 219(5): 914-922.
37.	Massicotte L, Lenis S, Thibeault L, et al. Effect of low central venous pressure and phlebotomy on blood product transfusion requirements during liver transplantations[J]. Liver Transpl, 2006, 12(1): 117-123.
38.	Yoo JG, Jang YH, Kim JM, et al. Changes in renal function by low dose dopamine in patients undergoing hepatectomy with low central venous pressure maintenance[J]. Korean J Anesthesiol, 2004, 47: 796-802.
39.	Drieghe B, Manoharan G, Heyndrickx GR, et al. Dopamine-induced changes in renal blood flow in normals and in patients with renal dysfunction[J]. Catheter Cardiovasc Interv, 2008, 72(5): 725-730.
40.	Rees M, Plant G, Wells J, et al. One hundred and fifty hepatic resections: evolution of technique towards bloodless surgery[J]. Br J Surg, 1996, 83(11): 1526-1529.
41.	Tranchart H, O’rourke N, Van Dam R, et al. Bleeding control during laparoscopic liver resection: a review of literature[J]. J Hepatobiliary Pancreat Sci, 2015, 22(5): 371-378.
42.	Lutz JT, Valentín-Gamazo C, Görlinger K, et al. Blood-transfusion requirements and blood salvage in donors undergoing right hepatectomy for living related liver transplantation[J]. Anesth Analg, 2003, 96(2): 351-355.
43.	Kim YK, Chin JH, Kang SJ, et al. Association between central venous pressure and blood loss during hepatic resection in 984 living donors[J]. Acta Anaesthesiol Scand, 2009, 53(5): 601-606.
44.	Niemann CU, Feiner J, Behrends M, et al. Central venous pressure monitoring during living right donor hepatectomy[J]. Liver Transpl, 2007, 13(2): 266-271.
45.	Chhibber A, Dziak J, Kolano J, et al. Anesthesia care for adult live donor hepatectomy: our experiences with 100 cases[J]. Liver Transpl, 2007, 13(4): 537-542.
46.	Anter AM, Bondok RS. Peripheral venous pressure is an alternative to central venous pressure in paediatric surgery patients[J]. Acta Anaesthesiol Scand, 2004, 48(9): 1101-1104.
47.	Hoftman N, Braunfeld M, Hoftman G, et al. Peripheral venous pressure as a predictor of central venous pressure during orthotopic liver transplantation[J]. J Clin Anesth, 2006, 18(4): 251-255.
48.	Stéphan F, Rezaiguia-Delclaux S. Usefulness of a central venous catheter during hepatic surgery[J]. Acta Anaesthesiol Scand, 2008, 52(3): 388-396.
49.	Choi SJ, Gwak MS, Ko JS, et al. Can peripheral venous pressure be an alternative to central venous pressure during right hepatectomy in living donors?[J]. Liver Transpl, 2007, 13(10): 1414-1421.

1. Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade[J]. Ann Surg, 2002, 236(4): 397-406.
2. Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma[J]. Ann Surg, 2009, 249(4): 617-623.
3. Stephenson KR, Steinberg SM, Hughes KS, et al. Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases[J]. Ann Surg, 1988, 208(6): 679-687.
4. Kooby DA, Stockman J, Ben-Porat L, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases[J]. Ann Surg, 2003, 237(6): 860-869.
5. Poon RT. Current techniques of liver ransaction[J]. HPB (Oxford), 2007, 9(3): 166-173.
6. Fan ST, Mau Lo C, Poon RT, et al. Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience[J]. Ann Surg, 2011, 253(4): 745-758.
7. 冯龙, 冯泽国, 蔡守旺, 等. 控制性低中心静脉压技术在精准肝切除术中的应用[J]. 军医进修学院学报, 2012, 18(5): 482-484.
8. Bui LL, Smith AJ, Bercovici M, et al. Minimising blood loss and transfusion requirements in hepatic resection[J]. HPB (Oxford), 2002, 4(1): 5-10.
9. Choukèr A, Schachtner T, Schauer R, et al. Effects of pringle manoeuvre and ischaemic preconditioning on haemodynamic stability in patients undergoing elective hepatectomy: a randomized trial[J]. Br J Anaesth, 2004, 93(2): 204-211.
10. Koea JB, Batiller J, Patel B, et al. A phase Ⅲ, randomized, controlled, superiority trial evaluating the fibrin pad versus standard of care in controlling parenchymal bleeding during elective hepatic surgery[J]. HPB (Oxford), 2013, 15(1): 61-70.
11. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effects on blood loss during liver resection[J]. Br J Surg, 1998, 85(8): 1058-1060.
12. Melendez JA, Arslan V, Fischer ME, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction[J]. J Am Coll Surg, 1998, 187(6): 620-625.
13. Smyrniotis V, Kostopanagiotou G, Theodoraki K, et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections[J]. Am J Surg, 2004, 187(3): 398-402.
14. Wang WD, Liang LJ, Huang XQ, et al. Low central venous pressure reduces blood loss in hepatectomy[J]. World J Gastroenterol, 2006, 12(6): 935-939.
15. Li Z, Sun YM, Wu FX, et al. Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy[J]. World J Gastroenterol, 2014, 20(1): 303-309.
16. Kambakamba P, Slankamenac K, Tschuor C, et al. Epidural analgesia and perioperative kidney function after major liver resection[J]. Br J Surg, 2015, 102(7): 805-812.
17. De Hert SG, Preckel B, Schlack WS. Update on inhalational anaesthetics[J]. Curr Opin Anaesthesiol, 2009, 22(4): 491-495.
18. Soonawalla ZF, Stratopoulos C, Stoneham M, et al. Role of the reverse-Trendelenberg patient position in maintaining low-CVP anaesthesia during liver resections[J]. Langenbecks Arch Surg, 2008, 393(2): 195-198.
19. Hasegawa K, Takayama T, Orii R, et al. Effect of hypoventilation on bleeding during hepatic resection: a randomized controlled trial[J]. Arch Surg, 2002, 137(3): 311-315.
20. Feng ZY, Xu X, Zhu SM, et al. Effects of low central venous pressure during preanhepatic phase on blood loss and liver and renal function in liver transplantation[J]. World J Surg, 2010, 34(8): 1864-1873.
21. Jarnagin WR, Gonen M, Maithel SK, et al. A prospective randomized trial of acute normovolemic hemodilution compared to standard intraoperative management in patients undergoing major hepatic resection[J]. Ann Surg, 2008, 248(3): 360-369.
22. Yoneda G, Katagiri S, Yamamoto M. Reverse trendelenburg position is a safer technique for lowering central venous pressure without decreasing blood pressure than clamping of the inferior vena cava below the liver[J]. J Hepatobiliary Pancreat Sci, 2015, 22(6): 463-466.
23. Rahbari NN, Koch M, Zimmermann JB, et al. Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial[J]. Ann Surg, 2011, 253(6): 1102-1110.
24. Zhu P, Lau WY, Chen YF, et al. Randomized clinical trial comparing infrahepatic inferior vena cava clamping with low central venous pressure in complex liver resections involving the Pringle manoeuvre[J]. Br J Surg, 2012, 99(6): 781-788.
25. Kato M, Kubota K, Kita J, et al. Effect of infra-hepatic inferior vena cava clamping on bleeding during hepatic dissection: a prospective, randomized, controlled study[J]. World J Surg, 2008, 32: 1082-1087.
26. Moulton CA, Chui AK, Mann D, et al. Does patient position during liver surgery influence the risk of venous air embolism?[J]. Am J Surg, 2001, 181(4): 366-367.
27. Sand L, Rizell M, Houltz E, et al. Effect of patient position and PEEP on hepatic, portal and central venous pressures during liver resection[J]. Acta Anaesthesiol Scand, 2011, 55(9): 1106-1112.
28. Guo Y, Lin CX, Lau WY, et al. Hemodynamics and oxygen transport dynamics during hepatic resection at different central venous pressures in a pig model[J]. Hepatobiliary Pancreat Dis Int, 2011, 10(5): 516-520.
29. 黄婵燕, 华赟鹏, 邬艳, 等. 控制性低中心静脉压对右半肝切除术患者术后重要脏器功能的影响[J]. 中华普通外科学文献: 电子版, 2013, 7(1): 30-35.
30. Barton JS, Riha GM, Differding JA, et al. Coagulopathy after a liver resection: is it over diagnosed and over treated?[J]. HPB (Oxford), 2013, 15(11): 865-871.
31. Guo JR, Shen HC, Liu Y, et al. Effect of acute normovolemic hemodilution combined with controlled low central venous pressure on cerebral oxygen metabolism of patients with hepalobectomy[J]. Hepatogastroenterology, 2015, 61(136): 2321-2325.
32. Yigitler C, Farges O, Kianmanesh R, et al. The small remnant liver after major liver resection: how common and how relevant?[J]. Liver Transpl, 2003, 9(9): S18-S25.
33. Moug SJ, Smith D, Wilson IS, et al. The renal sequelae of a novel triphasic approach to blood loss reduction during hepatic resection[J]. Eur J Surg Oncol, 2006, 32(4): 435-438.
34. Armstrong T, Welsh FK, Wells J, et al. The impact of pre-operative serum creatinine on short-term outcomes after liver resection[J]. HPB (Oxford), 2009, 11(8): 622-628.
35. Correa-Gallego C, Berman A, Denis SC, et al. Renal function after low central venous pressure-assisted liver resection: assessment of 2116 cases[J]. HPB (Oxford), 2015, 17(3): 258-264.
36. Squires MH, Lad NL, Fisher SB, et al. The effect of preoperative renal insufficiency on postoperative outcomes after major hepatectomy: a multi-institutional analysis of 1,170 patients[J]. J Am Coll Surg, 2014, 219(5): 914-922.
37. Massicotte L, Lenis S, Thibeault L, et al. Effect of low central venous pressure and phlebotomy on blood product transfusion requirements during liver transplantations[J]. Liver Transpl, 2006, 12(1): 117-123.
38. Yoo JG, Jang YH, Kim JM, et al. Changes in renal function by low dose dopamine in patients undergoing hepatectomy with low central venous pressure maintenance[J]. Korean J Anesthesiol, 2004, 47: 796-802.
39. Drieghe B, Manoharan G, Heyndrickx GR, et al. Dopamine-induced changes in renal blood flow in normals and in patients with renal dysfunction[J]. Catheter Cardiovasc Interv, 2008, 72(5): 725-730.
40. Rees M, Plant G, Wells J, et al. One hundred and fifty hepatic resections: evolution of technique towards bloodless surgery[J]. Br J Surg, 1996, 83(11): 1526-1529.
41. Tranchart H, O’rourke N, Van Dam R, et al. Bleeding control during laparoscopic liver resection: a review of literature[J]. J Hepatobiliary Pancreat Sci, 2015, 22(5): 371-378.
42. Lutz JT, Valentín-Gamazo C, Görlinger K, et al. Blood-transfusion requirements and blood salvage in donors undergoing right hepatectomy for living related liver transplantation[J]. Anesth Analg, 2003, 96(2): 351-355.
43. Kim YK, Chin JH, Kang SJ, et al. Association between central venous pressure and blood loss during hepatic resection in 984 living donors[J]. Acta Anaesthesiol Scand, 2009, 53(5): 601-606.
44. Niemann CU, Feiner J, Behrends M, et al. Central venous pressure monitoring during living right donor hepatectomy[J]. Liver Transpl, 2007, 13(2): 266-271.
45. Chhibber A, Dziak J, Kolano J, et al. Anesthesia care for adult live donor hepatectomy: our experiences with 100 cases[J]. Liver Transpl, 2007, 13(4): 537-542.
46. Anter AM, Bondok RS. Peripheral venous pressure is an alternative to central venous pressure in paediatric surgery patients[J]. Acta Anaesthesiol Scand, 2004, 48(9): 1101-1104.
47. Hoftman N, Braunfeld M, Hoftman G, et al. Peripheral venous pressure as a predictor of central venous pressure during orthotopic liver transplantation[J]. J Clin Anesth, 2006, 18(4): 251-255.
48. Stéphan F, Rezaiguia-Delclaux S. Usefulness of a central venous catheter during hepatic surgery[J]. Acta Anaesthesiol Scand, 2008, 52(3): 388-396.
49. Choi SJ, Gwak MS, Ko JS, et al. Can peripheral venous pressure be an alternative to central venous pressure during right hepatectomy in living donors?[J]. Liver Transpl, 2007, 13(10): 1414-1421.

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控制性低中心静脉压在肝切除术中的应用进展

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