The Effect Of Acute Hypervolemic Hemodilution On The Coagulation Function In Patients Undergoing Meningioma Resection

Acute hypervolemic hemodilution(AHH) is an effective method of blood conservation, the purpose of which is to reduce bleeding and blood transfusion and avoid a variety of adverse reactions and complications caused by allogeneic blood transfusion. In order to achieve the purpose of blood conservation, the clinical applications become increasingly widespread. Because of different opinions upon the implementation methods, the degree of tolerance, we try to explore the safety, effectiveness and use of this kind of blood protection method comprehensively.Objective: To compare the influences of blood coagulation function upon different liquids for acute hypervolemic hemodilution in patients undergoing meningioma resection.Methods: Thirty ASAⅠorⅡadult patients, undergoing scheduled elective meningioma operation were randomly divided into 3 groups: Group R(AHH with lactate Ringer’s solution), Group H(AHH with 6%Hydroxyethyl Starch130/0.4), Group G(AHH with 4%Gelofusine), with 10 patients in each group. In all patients, lactate Ringer’s solution 6-8mlkg-1·h-1 was infused to compensate for preoperative fluid restriction after midnight. Left radialis artery was cannulated for intra-arterial Pressure monitoring before induction of anesthesia. All patients had same general anesthetic techiques. The patients were premedicated with intravenous injection of atropine 0.5mg. Anesthesia was induced with midazolam 0.1mg·kg-1, Sufentanil o.5μg·kg-1, propofol 2mg·kg-1 and cisatracurium 0.15mg·kg-1 and maintained with propofol 4-6mg·kg-1·h-1 and remifentanil 0.1-0.3μg·kg-1·min-1. Muscle relaxation was maintained with intermittent intravenous boluses of cisatracurium. The patients were mechanieally ventilated(VT=8-10ml·kg-1, RR=10-12bpm) after tracheal intubation and right internal jugular vein was cannulated for fluid resuscitation and CVP monitoring. AHH was Performed by infusing 20ml·kg-1 solution(Group R, AHHD with laetated Ringer’s solution; Group H, AHH with 6%Hydroxyethyl Starch130/0.4, Group G, AHH with 4%Gelofusine) within(25±5) min after induction of anesthesia. Intraoperative blood loss was replaced with equal volume of 6%Hydroxyethyl Starch130/0.4 or 4%Gelofusine. Blood transfusion was considered to maintain HCT>25% when HGB<80g·L-1 and HCT<25%. Venous blood samples were taken before AHH(T0), at the end of AHH(T1), 30 minute after AHH(T2) for determining the following data: Blood routine examination(including HCT, PLT), CCT(including PT, APTT), parameters of rapid thrombelastography(TEG-ACT, R, K, Angle, MA). HR, MAP, CVP, Sp O2, Pet CO2 were monitored continually during the whole operation. Measurement data was expressed as mean ± standard deviation( x ±s). Statistical package(IBM SPSS Statistics 21) was used for processing all the data. Groups were compared using univariate analysis of variance, Within group was compared using analysis of variance for repeated measurements. Count data using chi square comparing test. P<0.05 was considered that the difference has statistical significance.Results: 1 General data: The there groups were comparable with respect to age, sex ratio, body weight, blood volume expansion time and blood volume expansion(P>0.05)(Table 1). 2 There were no statistically significant differences among groups on MAP, CVP, PLT before AHH(P>0.05). After AHH, HR had no significant difference in all three groups(P>0.05). Within three groups, MAP increased significantly after AHH compared with baseline value before AHH in group H and G(P<0.01). ECG and Pet CO2 had no abnormal changes in the whole AHH. Within three groups, the CVP increased significantly at T1, T2 compared with T0(P<0.05 or P<0.01). Compare between groups: There were statistically significant differences between group H, G and group R on CVP after AHH(P<0.01). Group H and group G were significantly higher than that in group R on blood volume expansion rate(P<0.01). Changes on PLT: Within three groups, the PLT decreased significantly at T1, T2 compared with T0(P<0.05 or P<0.01). Compare between groups: There were statistically significant differences between group H, G and group R after AHH(P<0.01)(Table 2). 3 Changes on APTT, PT: There were no statistically significant differences among three groups before AHH(P>0.05). Within three groups, the time prolonged significantly at T1, T2 compared with T0 in group H and group G(P<0.05 or P<0.01). Compare between groups: There were statistically significant differences between group H, G and group R after AHH(P<0.05 or P<0.01)(Table 3). 4 Change on r-TEG parameters: All the parameters among three groups had no significant differences before AHH. TEG-ACT: Within three groups, the TEG-ACT prolonged significantly at T1, T2 compared with T0 in group H and group G(P<0.01). Compare between groups: There were statistically significant differences between group H, G and group R after AHH(P<0.05 or P<0.01). R-time: The R-time had no statistically significant differences within three groups(P>0.05). Compare between groups: There were statistically significant differences between group H, G and group R after AHH(P<0.05 or P<0.01). K-time and Angle: There were no statistically significant differences among groups on K-time and Angle(P>0.05). Within three groups, K-time and Angle had statistically significantly at T1, T2 compared with T0 in group H(P<0.05). MA: Within three groups, the MA decreased significantly at T1, T2 compared with T0 in group H and group G(P<0.05). Compare between groups: There were statistically significant differences between group H, G and group R after AHH(P<0.05 or P<0.01)(Table 4).Conclusions: 1 AHH was Performed by infusing 20ml·kg-1 solution within(25±5) min, which is feasible and safe for patients undergoing meningioma. 2 Crystalloid and colloid solution can effectively expand the blood volume for meningioma resection patients. Compared with lactated Ringer’s solution on the effect of expanding the blood volume, 6%Hydroxyethyl starch 130/0.4 or 4%Gelofusine is a better choice,which is also suitable for preoperative AHH.3 Compared with lactated Ringer’s solution, 6%Hydroxyethyl Starch 130/0.4 and 4%Gelofusine have significant influence on blood coagulation, however, all parameters were within the safe levels. 4 r-TEG is more comprehensive than CCT for the whole process of coagulation, and then the time of results is shorter than CCT. r-TEG can be used for rapid clinical evaluation.