Clinical Application of Controlled Low Central Venous Pressure in Orthotopic Liver Transplantation

Objective:To investigate the security and effectivity of controlled low central venous pressure on orthotopic liver transplantation.Methods:Forty ASAⅡ～Ⅳ patients scheduled for orthotopic liver transplantation were randomly allocated to one of the two groups: normal central venous pressure group (group C, n=20) and controlled low central venous pressure group (group L, n=20). Group C was managed by normal central venous pressure (6～12 cm H2O),while group L was performed routinely with controlled central venous pressure(2～5 cm H2O). The levels of TNF-a,IL-6 and ET-1 were measured before operation (T1), anhepatic phase (T2), 30 min, 6 h and 24 h after reperfusion phase (T3,T4,T5). Plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) 30min, 6 h and 24 h after reperfusion phase were measured. Concentrations of blood urea nitrogen and serum creatinine before operation, 24 h after reperfusion phase were measured. The volume of blood loss and volume of blood transfused were measured. Results: The levels of TNF-a,IL-6 and ET-1 were significantly increased at T3,T4,T5 in two groups. The levels of TNF-a,IL-6 , ET-1 ALT and AST in the T3,T4 and T5 in group L were lower than those in group C (P0.05 or P0.01).Renal function was not affected by controlled low central venous pressure. The volume of blood loss and volume of blood transfused in group L were significantly less than that of group C(P0.01).Conclusion:The controlled low central venous pressure during orthotopic liver transplantation is effective in reducing blood loss and blood infusion, reducing liver ischemia-reperfusion injury,and may be beneficial for renal function.