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To explore the effect of acute hypervolemic hemodilution (AHH) with bicarbonated Ringer's solution (BRS) on perioperative serum S100ß protein (S100ß) and neuron-specific enolase (NSE) in elderly patients undergoing spine surgery. Ninety patients with lumbar spondylolisthesis and fracture surgery admitted to our hospital from January 2022 to August 2022 were selected as the study subjects, and they were randomly and equally divided into group H1 (AHH with BRS), group H2 (AHH with lactated Ringer's solution) and group C (no hemodilution). The serum contents of S100ß and NSE of the three groups at different times were evaluated. There were significant differences in the incidence of postoperative cognitive dysfunction (POCD) among the three groups at T1 and T2 (P < 0.05). There were obvious differences in the contents of S100ß and NSE among the three groups at T1 and T2 (P < 0.001), with no overt difference in the incidence of perioperative complications among the three groups (P > 0.05). The use of AHH with BRS can effectively reduce the effect on cognitive function in the elderly with spine surgery, which greatly reduces the nervous system injury, and has certain application value in clinic.
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OBJECTIVE: To compare the effect of acute hypervolemic hemodilution and conventional infusion in prostate cancer patients undergoing laparoscopic radical prostatectomies. METHODS: A total of 87 patients with prostate cancer who underwent laparoscopic radical prostatectomies in our hospital were retrospectively analyzed. The patients were randomly divided into a control group (the CNG, n=43, conventional infusion) and an observation group (the OG, n=44, acute hypervolemic hemodilution). Blood gas analyses were performed at different time points, and the patients' cognitive dysfunction was evaluated. RESULTS: The intraoperative blood transfusion rates of the OG and the CNG were 11.36% and 30.23%. The average intraoperative blood transfusions in the OG and the CNG were (315.46±24.49) ml and (486.95±42.17) ml (P < 0.05). The CVP and JVP levels in the OG and the CNG at T2 and T3 were significantly higher than the levels at T0 (P < 0.05). The Hb levels of the CNG at T3 and T4 were lower than they were at T0 (P < 0.05), and the Hb level in the OG at T4 was lower than it was at T1 (P < 0.05). The Hb levels in the CNG at T3 and T4 were lower than they were at T1 (P < 0.05), and the Hb levels in the OG at T1 and T2 were lower than they were in the CNG (P < 0.05). The MMSE cognitive function scores were lower than the scores recorded on the day before the operations (P < 0.05). CONCLUSION: Acute hypervolemic hemodilution in laparoscopic radical prostatectomy patients can maintain their hemodynamics in a stable state, help reduce blood transfusion, improve the oxygen supply to the brain tissue to maintain the supply and demand balance, and reduce the impact on the patients' cognitive function.
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OBJECTIVE: To explore the influences of acute hypervolemic hemodilution(AHH) on serum levels of S-100ß protein, neuron specific enolase(NSE) and postoperative cognitive dysfunction POCD in elderly patients with spinal surgery. METHODS: A total of 80 cases elderly patients requiring elective spinal operation were divided into AHH group and C group according to random digits table, 40 cases in each group, with ASA grade I-II. The patients in AHH group were infused 6% hydroxyethyl starch 130/0.4 at a rate of 20 ml/min after anesthesia induction, and blood volume increased by about 20%, the patients in C group were not received AHH, anesthesia and surgical methods were the same as those in AHH group. Intraoperative blood volume, allogeneic blood transfusion and urine volume were recorded. Mean arterial pressure(MAP), heart rate(HR), central venous pressure(CVP) at preoperative 1 d, 1 h after the start of surgery, end of operation, 12 h after surgery were observed. Arterial blood oxygen content (CaO2), venous blood oxygen content (CjvO2), arteriovenous oxygen content difference (Da-jvO2), and cerebral oxygen uptake(CERO2) were measured at 1 d before surgery, 15 min after surgery, 45 min after surgery, end of surgery. Mini-mental state examination(MMSE) score and serum levels of S-100ß protein, NSE were measured at 1 d before surgery, 1, 3, 7 d after surgery. POCD rates of two groups were recorded. RESULTS: Intraoperative blood loss and allogeneic blood transfusion in AHH group was significantly lower than those in C group(P<0.05), and the urine volume was significantly higher than that in C group (P<0.05). Compared with preoperative 1 day, MAP was decreased and CVP was increased at end of surgery in AHH group, compared with C group at the same time, MAP was lower and CVP was higher in AHH group, but both were in normal range. Compared with preoperative 1 day and C group, the levels of Da-jvO2 and CERO2 in AHH group was decreased at 15, 45 min after the start of the operation and end of surgery(P<0.05). Compared with preoperative 1 day, MMSE scores of two groups at 1 day after surgery was decreased (P<0.05), the levels of S-100ß protein and NSE were increased(P<0.05), and restored at 3, 7 days after surgery. There was statistical difference in MMSE scores, the levels of S-100ß protein, NSE at 1 day after surgery between two groups (P<0.05). There was no statistical difference in POCD rate between two groups(P>0.05). CONCLUSIONS: AHH can significantly reduce intraoperative blood loss and blood transfusion in elderly patients with spinal surgery, and decrease the levels of S-100ß protein and NSE, does not increase the risk of the occurrence of POCD.
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Hemodilution , Aged , Humans , Phosphopyruvate Hydratase , Postoperative Period , S100 Calcium Binding Protein beta SubunitABSTRACT
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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Preoperative acute hypervolemic hemodilution (AHHD) is a technique used in anesthesia to reduce the number of blood cells lost during intraoperative bleeding. The aim of the present study was to evaluate the effect of the hypervolemic hemodilution of 6% hydroxyethyl starch 130/0.4 on the EC50 of propofol at two clinical endpoints. A total of 20 patients undergoing AHHD following epidural anesthesia were studied, and 20 patients who did not receive hemodilution were used as a control group. All patients were American Society of Anesthesiologists grade I, aged 20-40 years and undergoing hip arthroplasty surgery. In the AHHD group, 10 ml/kg lactated Ringer's solution was infused over 20 min at the same time as the epidural test dose. The infusion was followed by the infusion of 6% hydroxyethyl starch 130/0.4 over 30 min. Patients in the control group received 10 ml/kg Ringer's solution over 50 min. Propofol was then delivered by a Diprifusor target-controlled infusion. The predicted blood and effect-site propofol concentrations were recorded at loss of consciousness (LOC) and return of consciousness (ROC). Probit analysis was used to estimate the values for predicted blood and effect-site concentrations at the two clinical endpoints. The results showed that the potency of propofol was decreased during AHHD. Compared with the controls, the predicted blood and effect-site concentrations of propofol at LOC were higher in patients of the hemodilution group, resulting in higher EC50 values (P=0.001 and 0.025, respectively). At ROC, the effect-site EC50 was 2.9 µg/ml [95% confidence interval (CI), 2.8-3.0] in hemodilution patients and 2.5 µg/ml (95% CI, 2.2-2.6) in control patients (P=0.001). With AHHD, the LOC time was significantly longer and the propofol dose was higher, while ROC times were comparable. In conclusion, AHHD increases the requirement for propofol at LOC and prolongs LOC time. Patients with AHHD recovered consciousness at higher effect-site concentrations of propofol. Thus, the induction dose of propofol should be increased during AHHD.
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Allogenetic transfusion has long been considered to be a relatively safe and extremely effective blood transfusion treatment. However, acute hypervolemic hemodilution (AHH) combined with the remifentanil-induced controlled hypotension (CH) have rarely been examined. Herein, 40 intracranial aneurysm surgery patients were randomly divided into nitroglycerin group (A group, n=20) and remifentanil group (B group, n=20). During intracranial aneurysm surgery, MAP, HR, Hb, and Hct were recorded. SjvO2, PjvO2, SaO2, PaO2 were measured, and CaO2, Da-jvO2, CjvO2, CERO2, VADL were calculated. In addition, The venous blood samples were collected for determining PT, TT, APTT, FBG, VIII, VWF and electrolytes. The results show that HR in nitroglycerin group dramatically accelerated and HR in remifentanil group slowed at 30 minutes after hypotension and 5 minutes after aneurysm occlusion (P<0.01) after hypotension. Compared with A group, the SjvO2 and CjvO2 of B group increased significantly and the Da-jvO2 and CERO2 decreased significantly at T3, T4. In addition, There were no significant differences between after AHH and before AHH in two groups (P>0.05) on TT, PT, APTT, FIB, VIII, VWF, Na(+), Cl(-), K(+), Ca(2+). These results suggest that AHH combined with remifentanil-based CH significantly lowered cerebral metabolic rate of oxygen and had effects on blood coagulation without clinical hemorrhagic signs increased and had important clinical significance for blood conservation.
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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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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.