| Backgrouds and Objective: The risks associated with transfusion of homologous blood have provide the impetus for the development if technique to minimize thansfiisions. Preoperative autologous blood donation, meticulous surgical technique, intra- and postoperative salvage of the patient's blood and its retransfusion, and acceptance of lower hemoglobin levels have all been used to avoid homologous blood donation. These years, with the development of the study on the mechanism of hemodilution, preoperative hemodilution has become one of the most frequently used and effective technique for blood saving. It include two major methods: Acute Normovolemic Hemodilution(ANH) and Acute Hypervolemic Hemodilution (AHH).AHH is a new way of saving blood that was put forth in the nineties of twentieth century, compared with ANH, AHH can save time and cost, and reduce contamination of blood, it will be more widely used in clinic gradually. But the systemic investigation in geriatric patients about it is very little in civil, people still have different opinions about its performing methods, the degree of tolerance et al, and its reliability and effectiveness of saving blood also has to be more discussed.6% Hydroxyethl starch(200/0.5) is a new generation of artificial colloid, and posses the unique effect of blocking for leakage of blood capillary except that it can obviously expand blood volume and ameliorate microcirculation filling and oxygen supply, and its incidence of harmful response is very low within clinicaldosage, so it is a better plasmatic substitute that was used in preoperative AHH and volume therapy at present. This topic is to aim at some questions of influence of AHH on physiological function in geriatric patients. Two groups of patients were adopted mild degree AHH with 6% HES or lactated Ringer's solution (LR), so as to observe the influence of AHH with the 6% HES and LR on hemodynamics, blood coagulation and renal function, and compare with the control group(AHH was not practiced on it) . The purpose of this study is to require into the reliability and effectiveness of preoperative AHH, and provide clinic bases for its administration in geriatric patients.Methods:Thirty elderly patients, aged>60yr, ASA I-II, HCT 35%, HB>110g.l-1 undergoing non-cardiac scheduled for elective surgery were randomly divided into 3 groups, with 10 in each group. In group A with 15mLkg-1 HES was infused intravenously at a rate of 25ml.min-1 after induction. In group B with the isodose of LR was infused at the same rate. In group C, any solutions wasn't infused. The anesthesia induction and drug of anesthesia maintenance is all the same. Heart Rate(HR), Electrocardiogram(ECG), Mean Arterial Pressure(MAP),and Central Venous Pressure(CVP) were monitored continually during the whole experiment Collect venous blood sample and urine sample before AHH(Ti), at the end of AHH(T2), 60 minute after AHH(T3), at the end of surgery(T4)and on the morning of the first postoperative day(Ts) for determining the following data:〣lood routine examination, record the Haematocrit (HCT)and Hemoglobin(HB); (2) venous plasma Prothrombin Time(PT), Activated Partial Thromboplastin Time(APTT) and Fibrinogen concentration (FIB);(3)Blood Urea Nitrogen(BUN),Creatinine(CR) and urinary N-acetyl-B-glucosaminidase (NAG). The data were expressed as mean 盨D. Statistical package (SPSS 10.0) was used for processing data.a=0.05 was considered that the difference has statistical significant. Result:1 .General dataThere were no significance difference among three groups on age, weight, baseline value of HCT and operation time.2.Change on hemodynamicsAt T1, there were no significant differences among three groups on MAP,HR and CVP (P>0.05). Between T1 time point and T2 time point, there were 1 patients in group A using Ephedrine to prevent the blood pressure from dropping,and 5 in group B with 10 in group C. There were significant difference on Ephedrine consumption between three groups. Compare between three groups on MAP: At T1 to T4, there were no sign... |
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