中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 41 Issue 3
Mar.  2025
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(3): 478-484

Effect of the nitroglycerin-controlled low central venous pressure technique on cerebral metabolic markers and cerebral blood oxygen saturation in patients undergoing laparoscopic hepatectomy for liver cancer

DOI: 10.12449/JCH250313

  • Operating Room，Haikou Hospital Affiliated to Xiangya Hospital of Central South University，Haikou 570208，China

Research funding:

Research Project in Health and Healthcare Industry of Hainan Province (21A200328);

Hainan Provincial Natural Science Foundation (821RC1143)

More Information
  • Corresponding author: WANG Bo， 461309329@qq.com （ORCID： 0009-0006-0336-3458）
  • Received Date: 2024-07-09
  • Accepted Date: 2024-10-15
  • Published Date: 2025-03-25
    Abstract
  •   Objective  To investigate the effect of the nitroglycerin-controlled low central venous pressure （CLCVP） technique on brain metabolic markers and cerebral blood oxygen saturation in patients undergoing laparoscopic hepatectomy for liver cancer， and to reduce the risk of neurological complications.  Methods  A total of 105 patients who underwent elective laparoscopic hepatectomy for liver cancer in Haikou Hospital Affiliated to Xiangya Hospital of Central South University from April 2020 to May 2023 were enrolled and randomly divided into CLCVP group with 54 patients and non-CLCVP group with 51 patients. The patients in the CLCVP group were treated with the nitroglycerin CLCVP technique during surgery， while those in the non-CLCVP group were given conventional surgical treatment. The two groups were compared in terms of the following indicators： perioperative indicators； hemodynamic parameters and cerebral oxygen metabolism before anesthesia induction （T0）， at 5 minutes after anesthesia induction （T1）， at 5 minutes after the beginning of liver parenchyma dissection （T2）， at 5 minutes after the end of hepatectomy （T3）， and immediately after the end of surgery （T4）； the changes in liver function parameters after surgery； the incidence rate of adverse reactions. The independent-samples t test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups； the analysis of variance with repeated measures was used for comparison between multiple time points.  Results  Compared with the non-CLCVP group， the CLCVP group had significantly lower intraoperative blood loss and intraoperative fluid infusion volume （t=5.408 and 7.220， both P<0.05）， while there were no significant differences between the two groups in time of operation， anesthesia time， extubation time， resuscitation time and intraoperative urine volume （all P>0.05）. Compared with the data at T0， both groups had significant reductions in mean arterial pressure， heart rate， and central venous pressure during surgery （all P<0.05）， and compared with the non-CLCVP group， the CLCVP group had significantly lower mean arterial pressure and central venous pressure （P<0.05） and a significantly higher heart rate （P<0.05） at T2 and T3. Compared with the data at T0， both groups had a significant reduction in Ca-jvDO2 at T2‍ ‍—‍ ‍T4 time points （all P<0.05）， while there was no significant difference in Ca-jvDO2 between the two groups at each time point （all P>0.05）. Compared with the data at T0， the CLCVP group had a significant reduction in rSO2 at T2‍ ‍—‍ ‍T4 time points （all P<0.05）， and the CLCVP group had a significantly lower level of rSO2 than the non-CLCVP group at T2‍ ‍—‍ ‍T3 time points （both P<0.05）； there were no significant changes in CERO2 and Djv-aBL in either group at each time point （all P>0.05）. At 3 and 7 days after surgery， both groups had significant increases in the liver function parameters of aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， and total bilirubin （TBil） （all P<0.05）， and the CLCVP group had significantly lower levels of AST and ALT than the non-CLCVP group （all P<0.05）； there was no significant difference in TBil between the two groups at each time point （all P>0.05）. There was no significant difference in the incidence rate of perioperative complications between the two groups （χ2=0.729， P=0.394）.  Conclusion  The application of the nitroglycerin CLCVP technique in laparoscopic hepatectomy for liver cancer can reduce the amount of intraoperative blood loss in patients， but it is necessary to further enhance the monitoring of cerebral blood oxygen saturation during surgery， so as to reduce the risk of neurological complications as much as possible.

     

    • FullText(HTML)
  • loading
    • References(22)
  • [1]
    CHENG K, CAI N, ZHU JH, et al. Tumor-associated macrophages in liver cancer: From mechanisms to therapy[J]. Cancer Commun(Lond), 2022, 42( 11): 1112- 1140. DOI: 10.1002/cac2.12345.
    [2]
    CUI JK, LIU M, SHANG XK. Hepatectomy for liver metastasis of gastric cancer: A meta-analysis[J]. Surg Innov, 2019, 26( 6): 692- 697. DOI: 10.1177/1553350619856491.
    [3]
    ZHENG YK, WU CX, YAO ZX. Construction of an intraoperative bleeding prediction model for hepatic cancer resection based on machine learning and preoperative data[J]. J Fujian Med Univ, 2022, 56( 6): 552- 560. DOI: 10.3969/j.issn.1672-4194.2022.06.014.

    郑咏坤, 吴春香, 姚志雄. 基于机器学习和术前资料构建肝癌切除术中出血预测模型[J]. 福建医科大学学报, 2022, 56( 6): 552- 560. DOI: 10.3969/j.issn.1672-4194.2022.06.014.
    [4]
    LAN DT, LI MD, AN X, et al. Effect of laparoscopic regular hepatectomy on levels of serum AFP, Hcy and quality of life in postoperative patients with primary liver cancer[J]. J Mod Oncol, 2019, 27( 7): 1176- 1180. DOI: 10.3969/j.issn.1672-4992.2019.07.019.

    兰戴天, 李茂德, 安祥, 等. 腹腔镜规则性肝叶切除术对原发性肝癌患者术后血清AFP、Hcy水平及生存质量的影响[J]. 现代肿瘤医学, 2019, 27( 7): 1176- 1180. DOI: 10.3969/j.issn.1672-4992.2019.07.019.
    [5]
    PAN YX, WANG JC, LU XY, et al. Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: A double-blind randomized clinical trial[J]. Surgery, 2020, 167( 6): 933- 941. DOI: 10.1016/j.surg.2020.02.004.
    [6]
    HANG Y, YANG XY, LI WM, et al. Optimal central venous pressure of controllable low central venous pressure technique in hepatectomy[J/OL]. Chin J Hepat Surg(Electronic Edition), 2024, 13( 6): 813- 817. DOI: 10.3877/cma.j.issn.2095-3232.2024988.

    杭轶, 杨小勇, 李文美, 等. 可控性低中心静脉压技术在肝切除术中应用的最适中心静脉压[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13( 6): 813- 817. DOI: 10.3877/cma.j.issn.2095-3232.2024988.
    [7]
    LI JH, CHEN SK, ZHANG T, et al. Intermittent pringle maneuver combined with controlled low central venous pressure prolongs hepatic hilum occlusion time in patients with hepatocellular carcinoma complicated by post hepatitis B cirrhosis: A randomized controlled trial[J]. Scand J Gastroenterol, 2023, 58( 5): 497- 504. DOI: 10.1080/00365521.2022.2147802.
    [8]
    DAI HL, LU XL, YANG HJ. Effect and key points of controlled low central venous pressure for laparoscopic resection of hepatocellular carcinoma in elderly patients[J]. Chin J Curr Adv Gen Surg, 2019, 22( 3): 207- 209. DOI: 10.3969/j.issn.1009-9905.2019.03.010.

    戴华磊, 陆小丽, 杨洪吉. 控制性低中心静脉压技术用于腹腔镜下老年肝癌切除术的效果及操作要点[J]. 中国现代普通外科进展, 2019, 22( 3): 207- 209. DOI: 10.3969/j.issn.1009-9905.2019.03.010.
    [9]
    HASEGAWA Y, NITTA H, TAKAHARA T, et al. Anterior approach for pure laparoscopic donor right hepatectomy[J]. Surg Endosc, 2020, 34( 10): 4677- 4678. DOI: 10.1007/s00464-020-07649-7.
    [10]
    MORANDI A, RISALITI M, MONTORI M, et al. Predicting post-hepatectomy liver failure in HCC patients: A review of liver function assessment based on laboratory tests scores[J]. Medicina(Kaunas), 2023, 59( 6): 1099. DOI: 10.3390/medicina59061099.
    [11]
    LIN J, CHEN LQ, ZHOU YJ, et al. The application of controlled low central venous pressure technology under target-directed fluid therapy in liver surgery[J]. Zhejiang Clin Med J, 2022( 11): 1612- 1614.

    林靖, 陈良巧, 周艳瑾, 等. 目标导向液体治疗下控制性低中心静脉压技术在肝脏手术中应用[J]. 浙江临床医学, 2022( 11): 1612- 1614.
    [12]
    WU JX, DU XQ, CHEN K, et al. Predictive model of postoperative hypotension in patients undergoing hepatocellular carcinoma resection with controlled low central venous pressure[J]. J Clin Anesthesiol, 2024, 40( 8): 809- 813. DOI: 10.12089/jca.2024.08.005.

    吴俊雄, 杜小强, 陈坤, 等. 控制性低中心静脉压肝癌切除术患者术后低血压的预测模型[J]. 临床麻醉学杂志, 2024, 40( 8): 809- 813. DOI: 10.12089/jca.2024.08.005.
    [13]
    PENG J, PENG SL. The clinical application of controlled low central venous pressure(CLCVP) in laparoscopic hepatectomy: Key points, possible complications and related management[J]. Chin J Pract Surg, 2022, 42( 9): 1039- 1041. DOI: 10.19538/j.cjps.issn1005-2208.2022.09.19.

    彭俊, 彭书崚. 腹腔镜肝切除术中控制性低中心静脉压技术实施要点与意外处理[J]. 中国实用外科杂志, 2022, 42( 9): 1039- 1041. DOI: 10.19538/j.cjps.issn1005-2208.2022.09.19.
    [14]
    GAO Y, WU W, LIU C, et al. Comparison of laparoscopic and open living donor hepatectomy: A meta-analysis[J]. Medicine(Baltimore), 2021, 100( 32): e26708. DOI: 10.1097/MD.0000000000026708.
    [15]
    SHA M, ZONG ZP, SHEN C, et al. Pure laparoscopic versus open left lateral hepatectomy in pediatric living donor liver transplantation: a review and meta-analysis[J]. Hepatol Int, 2023, 17( 6): 1587- 1595. DOI: 10.1007/s12072-022-10471-z.
    [16]
    GAO YS, YANG L, WU Y, et al. Application of remote ischemic preconditioning combined with controlled low central venous pressure in hepatectomy[J]. J Clin Hepatol, 2023, 39( 4): 856- 863. DOI: 10.3969/j.issn.1001-5256.2023.04.017.

    高苑淞, 杨柳, 吴悠, 等. 远隔缺血预处理联合控制性低中心静脉压在肝切除术中的应用[J]. 临床肝胆病杂志, 2023, 39( 4): 856- 863. DOI: 10.3969/j.issn.1001-5256.2023.04.017.
    [17]
    JUNRUNGSEE S, SUWANNIKOM K, TIYAPRASERTKUL W, et al. Efficacy and safety of infrahepatic inferior vena cava clamping under controlled central venous pressure for reducing blood loss during hepatectomy: A randomized controlled trial[J]. J Hepatobiliary Pancreat Sci, 2021, 28( 7): 604- 616. DOI: 10.1002/jhbp.969.
    [18]
    MU ZH, GAO J, XIN C, et al. Effects of controlled low central venous pressure on cerebral blood flow in patients undergoing open hepatectomy[J]. Chin J Anesthesiol, 2022, 42( 12): 1469- 1472. DOI: 10.3760/cma.j.cn131073.20221017.01212.

    穆子涵, 高巨, 辛超, 等. 控制性低中心静脉压用于开腹肝切除术对患者脑血流的影响[J]. 中华麻醉学杂志, 2022, 42( 12): 1469- 1472. DOI: 10.3760/cma.j.cn131073.20221017.01212.
    [19]
    ZHANG YQ, LI YL, CHEN J, et al. TCD monitoring cerebral blood flow of Trendelenburg position in gynecologic laparoscopic surgery[J]. J Clin Anesthesiol, 2015, 31( 5): 436- 438.

    张禹琦, 李玉兰, 陈军, 等. 妇科腹腔镜手术中Trendelenburg体位时脑血流动力学的变化[J]. 临床麻醉学杂志, 2015, 31( 5): 436- 438.
    [20]
    LI SC, YIN Y, WANG P, et al. Goal-directed fluid therapy during post-resection phase in low central venous pressure assisted laparoscopic hepatectomy: A randomized controlled superiority trial[J]. J Anesth, 2024, 38( 1): 77- 85. DOI: 10.1007/s00540-023-03282-5.
    [21]
    WANG FR, SUN DW, ZHANG NN, et al. The efficacy and safety of controlled low central venous pressure for liver resection: A systematic review and meta-analysis[J]. Gland Surg, 2020, 9( 2): 311- 320. DOI: 10.21037/gs.2020.03.07.
    [22]
    LI X, MA L, LIU J, et al. Safety and effectiveness of different levels of controlled low central venous pressure in patients undergoing laparoscopic liver resection[J]. Clin J Med Off, 2024, 52( 4): 369- 373. DOI: 10.16680/j.1671-3826.2024.04.10.

    李莘, 马丽, 刘杰, 等. 不同水平控制性低中心静脉压技术用于腹腔镜肝切除术患者安全性及有效性研究[J]. 临床军医杂志, 2024, 52( 4): 369- 373. DOI: 10.16680/j.1671-3826.2024.04.10.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(6)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (1692) PDF downloads(36) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return