The Study On Evaluating Hemodilution Effect With Different Liquids Through Hemoglobin Monitoring By Pulse Oximetry

Objective: To analyze the effect of hemodilution with different infusion quantity, in otherwords, to study the relationship between liquid volume and hemoglobin changes. So as toexplore the time law of different types of liquid about intravascular retention and tissuedistribution, which is the rule of hemoglobin concentration responding to changes ofhemodilution. By this method, we can discovery the hemodilution effectiveness of differentvolumes and different types of liquids and impact of expanded capacity during the process ofinstant and later. Through the study, we can provide strong evidences and guidances forreasonable application of hemodilution, blood transfusions and fluid treatment in the clinicalpractice.Methods: Select60patients in laparoscopic gastrointestinal surgery with general anesthesia,level ASA I~II, and randomly divide into2groups of30cases. Group W is infused with6%Hydroxyl starch (HES) at a rate of30ml/kg/h, and Group R is infused with Lactated Ringer’sSolution at the same rate, and two groups are underwent acute hypervolemic hemodilution for60minutes (AHHD). Record the monitoring indicators: value of noninvasive pulse oximetryhemoglobin (SpHb), arterial blood gas analysis (Hb), hematocrit(HCT), amount of transfusion,urine volume and valid infusion volume at6different points during hemodilution, before thehemodilution (T0)、undergoing hemodilution(T1、T2)、after the hemodilution(T3、T4、T5).Apply to dynamic model of liquid volume to analyze the rate of hemodilution and predict theefficiency of capacity expansion of liquid infusion through hydrokinetics.Results:①The correlation between the value of pulse oximetry hemoglobin (SpHb) andarterial blood gas analysis (Hb): The differences of each point between two groups is notstatistical significance (P>0.05). Two sets of indicators have the same trend over time (P>0.05).The two groups demonstrate high associativity by means of Pearson correlation analysis(P<0.05). The detected values of two types of techniques have a good consistency through theBland-Altman analysis.②Changes on degree of hemodilution: Between two groups, SpHb andHCT have decreasing tendencise in different degrees during the hemodilution (P<0.05), butthey have distinct variation tendency. While these two indicators are on the rise at late stage (T3~T5) respectively and group R is rebounded faster than group W (P<0.05).③Therelationship between blood volume and hemoglobin during hemodilution: According tocalculation, in group W, both increased plasma volume and rate of capacity dilution are3timesas much as that of group R, efficiency of capacity expansion is2.5times as much as that ofgroup R, ΔSpHb1(the difference between T0and T2) is2.5times as much as that of group R,ΔSpHb2(the difference between T0and T5) is3.5times as much as that of group R, andsimilarly there are all signifficant differences among two groups (P<0.05); There is a linearrelationship between increased plasma volume and the decrease in hemoglobin value during the60minutes of hemodilution period.④Changes of circulatory function during the hemodilutionand later: Variation tendencies of MAP and CVP between two groups are different (P<0.05).The stability of MAP of group W is better than that of group R, while the increase of CVP ingroup W at late stage is higher than that of group R (P<0.05), and there has similar trend in HRin two groups(P>0.05).⑤Changes of internal milieu after the hemodilution: Variationtendencies of pH value、Na+concentration、K+concentration and Ca2+concentration betweentwo groups are different(P<0.05). They present downtrend and then remain stable, but all theirvalues are in the normal range.⑥Adverse events during hemodilution: There are nostatistically significant differences in hypertension, hypotension, blood transfusion, fever,pulmonary edema and anastomotic fistula between two groups during the hemodilution(P>0.05).Conclusion:1. Two kinds of detection techniques have high relevance, consistency andaccuracy. They can be substitute for each other in clinical practice, and SpHb can accuratelyreflect the hemoglobin contents (Hb) under certain conditions.2.6%hydroxyethyl starch130/0.4possesses stronger effectiveness and longer duration ofvolume expansion than the equivalent amount of Lactated Ringer’S Solution duringhemodilution, and is applied better to rapid volume expansion.3. Two kinds of liquid have similar hemodilution effect at early stage, but hemodilution effectof6%hydroxyethyl starch130/0.4is superior to Lactated Ringer’S Solution at middle-latestage. 4. When two kinds of liquids make progress with hemodilution, the hemodynamic stability of6%hydroxyethyl starch130/0.4during anesthesia and operation obviously excels LactatedRinger’S Solution.5. Two kinds of liquids have no significant influence on internal milieu such as pH value andelectrolytes during hemodilution.6. There are no statistically significant differences in the comparison of incidence rates ofadverse events as well as postoperative recovery of patients between two kinds of liquids afterhemodilution.