Low central venous pressure reduces blood loss in hepatectomy

AIM: To investigate the effect of low central venous pressure (LCVP) on blood loss during hepatectomy for hepatocellular carcinoma (HCC). METHODS: By the method of sealed envelope, 50 HCC patients were randomized into LCVP group (n = 25) and control group (n = 25). In LCVP group, CVP was maintained at 2-4 mmHg and systolic blood pressure (SBP) above 90 mmHg by manipulation of the patient's posture and administration of drugs during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVR The patients' preoperative conditions, volume of blood loss during hepatectomy, volume of blood transfusion, length of hospital stay, changes in hepatic and renal functions were compared between the two groups. RESULTS: There were no significant differences in patients' preoperative conditions, maximal tumor dimension, pattern of hepatectomy, duration of vascular occlusion, operation time, weight of resected liver tissues, incidence of post-operative complications, hepatic and renal functions between the two groups. LCVP group had a markedly lower volume of total intraoperative blood loss and blood loss during hepatectomy than the control group, being 903.9 +/- 180.8 mL vs 2329.4 +/- 2538.4 (W=495.5, P < 0.01) and 672.4 +/- 429.9 mL vs 1662.6 +/- 1932.1 (W=543.5, P < 0.01). There were no remarkable differences in the pre-resection and post-resection blood losses between the two groups. The length of hospital stay was significantly shortened in LCVP group as compared with the control group, being 16.3 +/- 6.8 d vs 21.5 +/- 8.6 d (W= 532.5, P < 0.05). CONCLUSION: LCVP is easily achievable in technique. Maintenance of CVP <= 4 mmHg can help reduce blood loss during hepatectomy, shorten the length of hospital stay, and has no detrimental effects on hepatic or renal function. (c) 2006 The WJG Press. All rights reserved.