The Application With Acute Hypervolemic Hemodilution Combinate Controlled Hypotension In The Scoliolosis Operation

Objective:To evaluate the blood loss and blood transfusion of the acute hypervolemic hemodilution (AHH), and the acute hypervolemic hemodilution combinate controlled hypotension (CH) undergoing the corrective scoliosis surgery of intraoperative period .Methods:20 patients diagnose as scoliosis were investigated in this research, Twenty ASA (American society of anesthesiologists) grade I to II patients were treated with corrective surgery under the general anesthesia, and were randomly divided into group A (AHH n=10 )and group B (AHH combinate CH n=10 ). Both groups were adopted Composite-inhalation general anesthesia and intraoperative medication in the 2 group is same. Invasived artery and venous pressure were monitoring. All patients of the two groups were taken the 6% hydroxyethyl starch HES (130/0.4) infusion according to 15ml·kg-1 with the speed of 50ml·min-1 in half an hour before the operation. The volume of blood loss during operation was provided with the same volume of the 6% hydroxyethyl starch HES (130/0.4). The physiological need, abrosia loss and third space loss were substituted with Ringer lactate solution and 0.9% Sodium Chloride injection with the speed of 10 ml·kg-1·min-1.The junk such as sevoflurane, propofol, remifentanil were expended before the osteotomy for group B to send the MAP (mean arterial blood pressure) decrease to the level of about 70-80% of the basis MAP but not less than 55mmHg. We may use the GT (glyceryl trinitrate) with the constant speed of 3~6μg·kg-1·min-1 until the MAP being stable. Then maintain the MAP at the speed of 1~5μg·kg-1·min-1 ,and controlled hypotension can be stopped after bone graft fusion. Blood-transfusion can be taken to ensure the Hct (haematocrit) less than 30%, and Hb (hemoglobin) less than 80g/L when bone graft fusion was not completed. intraoperation of Arterial blood gas analysis was monitored. The Hct and Hb were recorded at five Time spots as following: preoperative (T0), after AHH and before the operation (T1), before the blood transfusion (T2), after the operation (T3), and prior to discharge (T4). And the volume of the blood loss and blood transfusion during the period of operation were also recorded. At last, calculated the blood loss per kilogram of these patients, and the variable of Hct.Results:The comparison of the difference of weight and age was not significant between two groups (P>0.05). Except for the Hct in the T1, the comparison of the difference of the Hct and Hb of each time spot was not significant between two groups (P>0.05). The Blood loss per-kilogram in group B was significantly less than that in group A (p<0.05). The variable of Hct with Blood transfusion per-kilogram in group B was significantly less than that in group A (p<0.05). The blood transfusion in the intraoperative period of corrective scoliosis surgery was significant (p<0.05), and the volume of the blood transfusion of group A was always higher than group B.Conclusion:Compared to the AHH, AHH combinating with CH can lead to decrease the volume of allogeneic blood transfusion in order to achieve the goal of lowering the risk of allogeneic blood transfusion and saving the volume of blood.