Effects of acute normovolemic hemodilution combined with intraoperative recycled autotransfusion on blood transfusion volume and coagulation function in elderly patients undergoing cardiac surgery / 中国输血杂志

ABSTRACT

【Objective】 To explore the effects of acute normovolemic hemodilution (ANH) combined with intraoperative recycled autotransfusion on blood transfusion volume and coagulation function in elderly patients undergoing cardiac surgery. 【Methods】 A total of 94 elderly patients undergoing cardiac surgery in the hospital were enrolled and randomly divided into observation group (n=47) and control group (n=47) between March 2020 and March 2022. The observation group was given ANH combined with intraoperative recycled autotransfusion, while control group was given routine allogeneic transfusion. The blood transfusion volume, oxygenation status, immune function, inflammatory indexes and adverse reactions in the two groups were compared. 【Results】 The banked blood transfusion volume was less in observation group than control group [(1.73±0.43) U vs (5.71±1.71) U, P<0.05]. At 6 h after surgery, blood oxygen saturation (SvO2) level was higher [(74.59±7.20) % vs (67.22±6.19) %], while oxygen uptake rate (ERO2) level was lower[(0.29±0.06) % vs (0.34±0.05) %] in observation group than control group (P<0.05). At day 1 after surgery, levels of CD3+, CD4+, CD4+ /CD8+ and natural killer cells (NK) were higher [(65.11±5.14) %, (46.93±5.17) %, (1.86±0.30), (8.35±1.23) % vs (57.45±7.24) %, (43.58±4.85) %, (1.47±0.36)%, (7.34±1.38) %], while CD8+ was lower [(25.17±4.01) % vs (30.39±5.06) %] in observation group than control group (P<0.05). At day 1 after surgery, levels of serum interleukin 6/8 (IL-6/8) and tumor necrosis factor-α (TNF-α) were lower in observation group than control group [(104.51±12.55) ng/L vs (125.81±14.96) ng/L, (351.42±52.86) ng/L vs (394.27±55.78) ng/L, (254.93±49.94) ng/L vs (323.60±52.63) ng/L, P<0.05]. The incidence of adverse reactions was lower in observation group than control group (4.26% vs 17.02%), P<0.05. 【Conclusion】 Recycled autotransfusion can reduce allogeneic transfusion volume in elderly patients undergoing cardiac surgery. There is no difference in the effects on blood routine or coagulation function between recycled autotransfusion and allogeneic transfusion. Compared with allogeneic transfusion, recycled autotransfusion can significantly improve oxygenation status, relieve immunosuppression and inflammation response, and reduce the risk of adverse reactions.