BACKGROUND This prospective randomized controlled study was designed to evaluate the effect of fluid restriction alone versus fluid restriction + low central venous pressure (CVP) on hepatic surgical field bleeding, intraoperative blood loss, and the serum lactate concentration in patients undergoing partial hepatectomy. METHODS One hundred forty patients undergoing partial hepatectomy with intraoperative portal triad clamping were randomized into a fluid restriction group (Group F) or fluid restriction + low CVP group (Group L). Both groups received limited fluid infusion before the liver lesions were removed. Ephedrine was administered if the systolic blood pressure (SBP) decreased to <90 mmHg for 1 min. When the urine output was <20 ml/h or the SBP was <90 mmHg for 1 min more than three times, an additional 200 ml of crystalline solution was quickly infused within 10 min. In addition to fluid restriction, patients in Group L received continuous nitroglycerin and esmolol infusion to maintain a low CVP. The duration of portal triad clamping, frequency of additional fluid infusion, frequency of ephedrine administration, intraoperative blood loss, extent of liver resection, and bleeding score of the hepatic surgical field were recorded. Arterial blood gas analysis was performed before anesthesia (T1), after liver dissection and immediately before liver resection (T2), 10 min after removal of the liver lesion (T3), and before the patient was discharged from the postanesthesia care unit (T4). RESULTS Being in the fluid restriction Group (Group F) (odds ratio = 5.04) and cirrhosis (odds ratio = 3.28) were risk factors for hepatic surgical field bleeding. Factors contributing to intraoperative blood loss were the operation time, duration of portal triad clamping, and extent of resection. No significant between-group difference was observed for blood loss or blood transfusion. The serum lactate concentration peaked at T3 in both groups. CONCLUSIONS Maintaining a lower CVP during hepatectomy provides an optimal surgical field but has no significant effect on intraoperative blood loss. Moreover, lower CVP does not increase the serum lactate concentration. TRIAL REGISTRATION "A comparative study of the effect fluid restriction and low CVP pressure on the oozing of blood in liver wounds and blood lactate in patients undergoing partial hepatectomy" was prospectively registered as a trial (registration number: ChiCTR-INR-17014172, date of registration: 27 December 2017).

中文翻译：

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低中心静脉压对部分肝切除患者肝手术视野出血和血清乳酸的影响：一项前瞻性随机对照试验。

背景技术这项前瞻性随机对照研究旨在评估仅进行体液限制与体液限制+低中心静脉压（CVP）对部分肝切除患者肝手术视野出血，术中失血以及血清乳酸浓度的影响。方法140例行术中门三联症夹紧术的部分肝切除患者被随机分为体液限制组（F组）或体液限制+低CVP组（L组）。两组均在肝病灶切除之前接受了有限的输液。如果收缩压（SBP）降至<90 mmHg 1分钟，则服用麻黄碱。当尿量<20 ml / h或SBP <90 mmHg持续1分钟超过3次时，在10分钟内迅速注入另外200毫升结晶溶液。除了限制液体外，L组患者还接受了连续的硝酸甘油和艾司洛尔输注，以维持较低的CVP。记录门静脉三联症钳夹的持续时间，额外输液的频率，麻黄碱的给药频率，术中失血量，肝切除的程度以及肝脏手术视野的出血评分。在麻醉前（T1），肝切除后和肝切除前（T2），肝病灶切除后10分钟（T3）以及从麻醉后护理单元出院前（T4）进行动脉血气分析。结果属于限液组（F组）（比值= 5.04）和肝硬化（比值= 3）。28）是肝外科手术场出血的危险因素。导致术中失血的因素包括手术时间，门诊三联夹的持续时间和切除范围。失血或输血未观察到明显的组间差异。两组的血清乳酸浓度均在T3达到峰值。结论肝切除术中维持较低的CVP可提供最佳的手术视野，但对术中失血没有明显影响。此外，较低的CVP不会增加血清乳酸浓度。试验注册“对进行部分肝切除术的患者进行液体限制和低CVP压对肝创面渗血和血乳酸影响的比较研究”已注册为试验（注册号：ChiCTR-INR-17014172，