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Objective To observe the clinical efficacy and safety of acute hypervolemic hemodilution (AHH) in combination with controlled hypotension (CH)and autologous blood transfusion (ABT)on spinal surgery. Methods For this study,we enrolled 50 patients undergoing spinal surgery and randomly divided them into two groups.The experimental group received AHH in combination with CH and ABT,while the control group received none of the above treatments.We compared the parameters such as hemodynamics,blood routine and coagulation, the amount of intraoperative bleeding,autologous and allogeneic blood transfusion volume,and regional cerebral oxygen saturation (rSO2)between the two groups.Results In the experimental group CVP increased,while invasive artery blood pressure, HCT, Hb, PLT and the amount of allogeneic blood transfusion decreased significantly compared with those of the control group (P＜0.05).As for the mean intraoperative blood loss, APTT,PT,TT,FIB and rSO2,there were no significant differences between the two groups (P＞0.05). Conclusion AHH in combination with CH and ABT can reduce the amount of allogeneic blood transfusion and has no adverse effect on hemodynamics,blood coagulation or cerebral oxygenation in spinal surgery patients.It is a safe and effective blood protection procedure during spinal surgery.
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Objective To investigate the effects of light acute hypervolemic hemodilution on early postop-erative cognitive function in elderly patients. Methods A total of 60 patients treated by radical surgery were equally randomized to an AHH and a non-AHH control group.Using the Mini-Mental State Examination scale (MMSE),we evaluated the cognitive function of the patients.We made comparisons between the two groups in the plasma S100β levels at T0(before anesthesia induction),T1(immediately after hemodilution),T2(immediately after operating),T(36 hour after operating)and T(424 hour after operating).Results The S-100β lever at T2、T3 and T4were markedly higher than T0in both groups(P<0.05);At T3and T4,the S-100β lever was higher in non-AHH control group than AHH group(P<0.05).There was no significant difference in the incidence of postopera-tive cognitive dysfunction between the two groups(P>0.05)There was no significant difference in the incidence of postoperative cognitive dysfunction between the two groups(P > 0.05). Conclusions AHH can significantly reduce plasma S100β in elderly patients,but there is no effect on early postoperative cognitive function.
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Objective Radical surgery is extensively used in the treatment of lung cancer in elderly patients .This study aimed to investigate the effects of acute hypervolemic hemodilution (AHVHD) on the cognitive function and plasma S100βof elderly people following radical surgery for lung cancer . Methods A total of 112 lung cancer patients treated by radical surgery were equally randomized to an AHVHD and a non-AHVHD control group .Using the Mini-Mental State Examination scale ( MMSE) , we evaluated the cognitive function of the patients .We made comparisons between the two groups in the cerebral oxygen metabolism indexes and plasma S100βlevels at T0(immediately after anesthesia induction), T1(15 min after hemodilution), T2(60 min after hemodilution), T3(60 min before the end of surgery ) and T4 ( at the end of surgery ) as well as MMSE scores before and after operation . Results At T1 , T2, T3, and T4, the values of jugular venous oxygen saturation in the AHVHD group were (75.1 ±4.3), (78.5 ±3.1), (79.1 ± 4.4), and (79.6 ±2.8) %, respectively, with time-dependent decreases in Da-jvO2 and cerebral oxygen extraction , and significantly higher than that at T0 (P<0.05) and those in the control group ([63.4 ±2.0], [63.9 ±1.8], [64.2 ±3.0], and [64.7 ±3.2]%) (P<0.05).The levels of plasma S100βat T1, T2, T3, and T4 were remarkably lower in the AHVHD group ([0.53 ±0.04], [0.52 ±0.07], [0.51 ±0.06], and [0.50 ±0.08] μg/L) than in the control ([0.64 ±0.06], [0.64 ±0.04], [0.65 ±0.05], and [0.67 ±0.06] μg/L), with statistically significant differences between the two groups at the same time point (P<0.05).At 1, 3, 5, and 7 days after surgery, the MMSE scores were markedly higher in the AHVHD group (24.3 ±1.7, 26.5 ±1.9, 27.8 ±1.3, and 28.1 ±1.0) than in the control (21.1 ±1.6, 24.0 ±2.1, 25.9 ±1.8, and 26.4 ±1.7) (P<0.05). Conclusion AHVHD can significantly improve cognitive function and reduce plasma S 100βin elderly patients following radical surgery for lung cancer , which may be related to cerebral oxygen metabolism .
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Objective To obeserve the effects of acute hypervolemic hemodilution(AHH) with hypertonic .sodium chloride hydroxyethyl starch 40(HSH 40) on hemodynamics and fluid balance in patients under general anesthesia.Methods Fifty patients undergoing radical surgery for gastral cancer under general anesthesia were randomly divided into 2 groups with 25 patients each.Acute hypervolemic bemodilution (AHH) was performed with HSH 40 6 ml/kg in group A or with hydroxyethyl statch(HES) 6 ml/kg in group,which was infused within 30 minuts.HR,MAP,CVP were recorded before(T_0),at 30 min (T_1),60 min (T_2) after infusionand and the end of operation (T_3).The amounts of bleeding,HSH 40 and HES and urine output were recorded as well.Results There were no significant diferences in HR and MAP between two groups at all time points.CVP was sighificantly higher at T_1-T_3 than that at To in two groups.The urine output was more in groups A than that in group B(P<0.05).Conclusion AHH with HSH 40 can effectively expand blood vlume and increase urine output in surgical patients under general anesthesia.
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Objective To study the effect of acute hypervolemic hemodilution on expression of serum chemokine interferon-inducible protein 10 in patients undergoing total hip replacement.Methods Twenty ASA Ⅰ or Ⅱ patients undergoing elective total hip replacement were randomly divided into 2 groups (n=10 each):HES group and LR group.The patients in HES group received 6% HES 20 ml/kg in rate of 30 ml/(kg·h) after anesthesia.The patients in LR group received Ringer's solution 20 ml/kg in rate of 30 ml(kg·h) after anesthesia.The blood loss,blood transfusion and the time of operation were recorded.Venous blood samples were taken before anesthesia (T0),at the begining of operation (T1),30 min after operation (T2),and at the end of operation (T3),in determination of serum chemokine interferon-inducible protein 10.Results The blood loss and the blood transfusion in HES group were (560±90)ml and (200±100) ml,those were significantly lower than that in LR group[(810±110)ml and (600±200)ml].The IP-10 concentrations were significantly increased at T2～T3 as compared to baseline value at T0 in both groups,but were higher in LP group[(77.3±13.8) ng/L and (89.9±15.1) ng/L]than those in HES group [(62.8±13.6) ng/L and (65.4±10.2) ng/L,P＜0.05].Conclusions Acute hypervolemic hemodilution can abate blood loss and blood transfusion during total hip replacement operation.Preoprative infusion with hydroxyethyl starch can attenuate the immunological depression during operation and anesthesia.
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Objective To study the effect of acute hypervolemic hemodilution on expression of plasma bac-tericidaL/permeability-increasing protein (BPI) in patients undergoing total hip replacement. Methods Twenty ASA Ⅰ-Ⅱ patients undergoing elective total hip replacement were randomly divided into two groups (n=10 for thesia. The blood loss,blood transfusion and the time of operation were recorded. Venous blood samples were taken before anesthesia (T0) ,at the begining of operation (T1) ,30 min after operation (T2) ,and at the end of operation (T3) for determination of plasma bactericidal/permeability-increasing protein. Results The blood loss and the blood transfusion in HES group were significantly lower than that of LR group[blood loss: (560±90)ml vs (810±110) ml and blood transfusion: (200±100) ml vs (600±200) ml,t=5.562 and 5.657,P<0.001]. The plasma BPI concentrations in HES group were significantly increased at T2～T3 as compared to baseline value at T0 [(8.9±1.6)μg/L,(13.4±1.2)μg/L and (4.9±1.2)μg/L,P<0.05]. The plasma BPI concentrations in LR group were significantly increased at T2～T3 as compared to baseline value at T0 [(7.3±1.2)μg/L,(9.9±0.8) μg/L and (5.0±1.1)μg/L,P<0.05],but were lower than those in HES group (t=2.530 and 7.674,P=0.021 and 0.001 ). Conclusion Acute hypervolemic hemodilution with 200/0.5 hydroxyethyl starch can reduce blood transfusion during total hip replacement operation and also can increase the BPI level which would beneficial for the immunological function.
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Autologous normovolemic hemodilution (ANH) is one of the methods to conserve blood donor (homologous). The decrease in hemoglobin (Hb) due to bleeding in major surgery will be minimized and the hematocrite (Hct) will be adjusted accordingly by this method. However, due to its impractical clinical application, another simpler hemodilution method is used, i.e. hypervolemic hemodilution (HHD), using 6% dextran 70 and lactated Ringer solutions. The aim of this randomized comparative study was to investigate the impacts of both hemodilution methods (ANH and HHD) on mean arterial pressure (MAP), heart rate (HR), hemoglobin (Hb) and hematocrite (Hct) in anesthetized patients undergoing major surgery. Fourteen (14) women fulfilling the inclusion and exclusion criteria were divided into 2 groups. Seven (7) women received ANH and seven (7) women received HHD method. There were significant statistical differences (P<0.05) between ANH and HHD groups in MAP and Hct after 1 minute (86.3±9.1 vs. 99.1±6.4 on MAP) and (27.3±1.7 vs. 31.5±4.4 on Hct) and after 20 minutes (87.7±7.3 vs. 98.3±6.8 on MAP) and (27.4± 1.7 vs. 3.6±4.8 on Hct) post-hemodilution respectively. There was no difference in HR and Hb. No statistical difference between the four parameters tested after 120 minutes post-hemodilution. It may be concluded that both methods worth to be used in clinical setting although further studies are required.
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Dextranos , Presión Arterial , HemodiluciónRESUMEN
Objective To observe the effect of acute hypervolemic hemodilution(AHH) combined with nicardipine controlled hypotension on hemodynamics changes in revision operation of total hip replacement.Methods Forty patients were divided into two groups according to the sequence of the surgery(odd number came into group A,even number came into group B,20 in each group).In group A,AHH was carried out with nicardipine controlled hypotension;group B was control group.AHH was carried out in both groups before anesthesia induction.6%voluven was transfused in group A at 15 mL?kg-1 and 30 mL?min-1 and nicardipine was transfused at 0.3-0.5 mL?kg-1?h-1 with MAP altering between 60 and 65 mmHg;Same quantity of physiological saline was transfused in group B.HR,MAP,CVP,Hb,Hct and Plt were recorded and observed at preoperation,1 h after AHH and 24 h after the operation.Results In group A after AHH with nicardipine controlled hypotension,MAP was obviously lower than pre-operation(P
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Objective To observe the clinical application of acute hypervolemic hemodilution (AHH) on patients undergoing surgical resection meningioma and the effects on the reduction of heterologous blood transfusion. Methods 40 scheduled mengingioma surgical patients were randomly divided into group I (AHH, n =20) and group II (control, n =20). All patients had same general anesthetic techniques. Amounts of heterologous blood transfusion and changes of postoperative hemoglobin in two group's were recorded and compared. Results BZ In AHH group 15 patients had no heterologous blood transfusion, 5 patients had 200～400 ml heterologous blood transfused. In control group all patients had 400～800ml heterologous blood transfused. Conclusion Acute hypervolemic hemodilution can significantly reduce the volumes of heterologous blood transfusion in mengingioma surgical patients.
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Objective To study the effects of acute hypervolemi c hemodilution (AHH) on the coagulation and cardiac function in elderly surgical p atients. Method Sixty surgical patients, aged 60 to70, ASA Ⅰ~ Ⅱ, were randomly divided into three groups (n=20 for each group). 6% HES 50 0~1000ml was infused in a rate of 20ml/min during vasodilation with isoflurane i nhalation (group 1), nitroglycerin (group 2), or nicardipine (group3) with the a id of an intravenous injection pump. The blood coagulation and cardiac functions were observed during hemodilution. Results No significant diff erence was found among the three groups on cardiac function and coagulation func tion during 500ml 6% HES infusion. When the volume of infusion was over 1000ml, the parameters of cardiac function increased and those of coagulation decrease d significantly (P
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Objective To observe the changes of hemorheology after acute hypervolemic hemodilution (AHH), and provide theoretic basis for clinical rationally using artificial plasma substitutes. Methods 90 patients undergoing hip joint operation were randomly divided into 3 groups (each group containing 30 patients), which received intravenous infusion of 6% hydroxyethyl starch (HES), 4% gelofusine or ringer's solution at 20ml/kg, respectively before operation. The whole blood viscosity, plasma viscosity, Hct, index of RBC aggregation and index of RBC deformation were measured before and after hemodilution. Resutls Hemodynamics was stable after AHH, and the amounts of perioperatively blood transfusion in the patients received colloid solution were obviously less than those in the patients received crystalloid solution. The whole blood viscosity, Hct and index of RBC aggregation significantly decreased after AHH in all the patients, and index of RBC deformation markedly increased in the patients after AHH with 6% HES. Conclusion AHH could effectively maintain hemodynamics stable, improve hemorheological condition and perfusion of microcirculation, enhance the tolerance of blood loss, and reduce homologous blood transfusion. Colloid solution was better than crystalloid solution for AHH.