| Objective: With the economic development and modern diagnosis progress and treatment technological improvement, there is a geriatric tendency in our country. So the category and quantity and difficulty of geriatric patients will gradually gain in clinic and the quantity of xenogenous blood is largely used during the operation for the geriatric patients. The complications caused by xenogenous transfusion become more and more seriously in recent years. Among these complications, Hepatitis and AIDS derived from the infection of virus have become a severe social problem. In new century, our country will face the more critical situation such as deficit of blood source and more serious infection after transfusion. So how to save blood in assuring safety of patients is an important medical studying topic. Preoperative autologous blood donation, postanaesthetic hemodilution (HD), meticulous surgical technique, intra- and postoperative salvage of the patient's blood and its recycling, 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 has become one of the most frequently used and effective technique for blood saving. It includes 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 the twentieth century, to compare with Acute normovolemic hemodilution (ANH), AHH can save time anddecrease cost, and reduce the blood contamination, it will be more widely spread to use in clinic gradually. But the systemic investigation on the using of AHH in geriatric patients, especially for the aging people, all of organ function in body will decrease, the influence of AHH on hemodynamics, constitution oxygenation, renal and immune function and the degree of tolerance is still more elementary and clinical study.In present, there is a lot of category of plasma substitute (Hydroxyethyl starch, Gelofusine, Dextran, Haemaccel, ect) in clinic. But hydroxyethyl starch is a kind of artificial colloid frequently used and posses the obviously expanding blood volume for its excellent physical and chemical characteristic. Among those, 6% hydroxyethyl starch(200/0.5 HES) is a kind of sodium chloride solutions of moderate molecular weight and low grade of substitute isotonic of hydroxyethyl starch. It can expand blood volume and supply with extracellular fluid. The effect of expanding blood volume is about 100% of inputing volume and will maintain 4~8hours of the effects on expanding blooding volume. It can also significantly decrease viscosity of blood and effectively maintain plasma colloid osmotic pressure and ameliorate microcirculation filling and oxygen supplying. But 6% hydroxyethyl starch (130/0.4 Voluven) is a new generation of sodium chloride solutions of hydroxyethyl starch. It is 130KD to mean molecular weigh and 0.4 to mol grade of substitute and 9:1 to method of substitute(C2/C6). It is 5.9Lto apparent volume of distribution and 1.4h to half life of plasma. Compared with HES, Voluven can also identically expand blood volume, but maintaining hour of the effect on expanding blooding volume is shorter than HES. Expect these, for the lower molecular weight and grade of substitute and the method of substitute improvement, Voluven can be easily excreted from kidney and its accumulation in plasma and tissue will apparently decrease. Its incidence of side effect and hypersensitivity is very low within clinical dosage and the effect of blood coagulation function is lower than that of HES. Voluven also posses the unique effect of blocking leakage of blood capillary. The maximum permitted dose for its excellent safety is 55ml.kg~-1 per day. So, it is a new kind of better plasma substitute and used in HD and volume therapy in clinic today. This thesis is to focus on some questions about the influence of AHH on human physiological and immune functionin geriatric patients undergoing thoracotomy. Two groups of patients were assigned mild degree AHH with Voluven or HES in one group, another one group as control, using lactated Ringer's solution. The influence of AHH with Voluven or HES on hemodynamics, constitution oxygenation, blood coagulation, renal and immune function was conducted and compared with the control group. The purpose of this study is to study the reliability and effectiveness of preoperative AHH, and provide data in clinical application in geriatric patients.Method: Thirty-six elderly patients undergoing resection of esophageal carcinoma(28) and pulmonary lobectomy(8),aged 60 through 70yr, ASA I -— II, HCT ^35%,HB>110g/l,were randomly divided into three groups, with twelve in each group. The total 15 ml.kg"1 of Voluven in group A, the isodose of HES in group B , the isodose of LR in group C were infused intravenously respectively. All of AHH were started at the time of 15 min before anesthesia induction and practiced at a rate of 20~35ml.min~1and achieved within 30 min. The anesthesia induction and drug of anesthesia maintenance were same. Heart rate(HR), Electrocardiogram(ECG), Mean Arterial Pressure(MAP) were monitored continually during the whole operation. Venous and arterial blood and urine specimen before AHH(Ti), after AHH(T2), 30 min after AHH(T3), 60 min after AHH(T4), 3 h after AHH(T5) were cllected for determining the following data: (D Blood routine test, 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), urinary a x -microglobulin( a x -MG) and P 2-microglobulin( 3 2- MG);@ arterial plasma Lactic Acid Concentration(LAC);d) serum Interleukin-6(IL-6). The data were expressed as mean ± SD. Statistical package for social science (SPSS 10.0) was employed for processing data, a =0. 05 was considered as the significant level.Results:1. General dataThere were no significant differences among three groups for age, weight, andoperative time.2. Change of hemodynamicsAt Tfc There were no significant differences among three groups for MAP and HR (P>0.05). Compare with MAP among three groups: The MAP in group C at T4,T5 were significantly lower than that of group A and B (P<0.05), but at the same time point, there were no significant differences between group A and B for MAP (P>0.05). At Ti.i, T1.2, T2, T3, there were no significant differences among three groups for MAP (P>0.05). Compare with MAP within groups: At T1.2, the MAP of all groups reach peak and were significantly higher than that at Ti (P<0.05). At Tl.l and T2 to T5 the MAP of group A and B, there were no significant differences compared with the MAP at Ti (P>0.05). At T4,T5,the MAP of group C were significantly lower than that at Ti (P<0.05). Compare with HR among three groups: There were no significant differences among three groups for HR (P>0.05). Compare with HR within groups: At T1.2, the HR of all groups reach peak and were significantly higher than t at Ti that of the same group (P<0.05). At Tl.l and T2 to T5, the HR of all groups, there were no significant differences compared with that at Ti (P>0.05).3. Changes of HCTAt Ti, There were no significant differences among three groups for HCT (P>0.05). Compare with HCT among three groups: The HCT in group C at T3 to T5 were significantly lower than that of group A and B (P<0.05), but at T2 there were no significant differences among three groups for HCT (P>0.05). At T2 to T5 there were no significant differences between group A and B for HCT (P>0.05). Compare with HCT within groups: In group A and B, at T2 to T5 the HCT of were significantly lower than at Ti that of the same group (P<0.05). At T2 to T4, the HCT of group C were significantly lower than that at Ti (P<0.05), but at T5, there was no significant differences compared with that at Ti (P>0.05).4. Changes of function of blood coagulationAt Ti, There were no significant differences among three groups on PT, APTT, Fib (P>0.05). There were no significant differences among or within three groups all time point on PT (P>0.05). Compare with APTT among three groups: The APTT in group A and B at T3?T4were significantly longer than that of group C (P<0.05). TheAPTT at T3, T4 of group B were significantly longer than that of group A (P<0.05). Compare with APTT within groups: At T3, T4, the APTT of group A and B were significantly longer than that at Ti (P<0.05). In group C, there were no significant differences at all the time point (P>0.05). Compare with Fib among three groups: There were no significant differences among three groups on HR (P>0.05). Compare with Fib within groups: At T5, the Fib of three groups were significantly lower than that at Ti (P<0.05).5. Changes of LACThere were no significant differences among three groups for LAC (P>0.05). At T2 to T5, the LAC of three groups were significantly lower than that at Ti in (P<0.05).6. Changes of Renal functionThere were no significant differences among or within three groups all time point for BUN and Cr (P>0.05). There were no significant differences among three groups for a j -MG (P>0.05). At T5, the a 1 -MG of three groups were significantly higher than that at Ti in (P<0.05). There were no significant differences among or within three groups all time point for P 2- MG (P>0.05).7. Changes of IL-6At TI, There were no significant differences among three groups for IL-6 (P>0.05). Compare with IL-6 among three groups: At T4, T5 the IL-6 of group C were significantly higher than that of group A and B (P<0.05), but at T2, T3, there were no significant differences among three groups on IL-6 (P>0.05). Compare with IL-6 within groups: In group A and B, there were no significant differences at all the time point (P>0.05). At T4, T5, the IL-6 were significantly higher than that at Ti in group C (P<0.05).8. Changes of volume of blood outputing and inputingThere were no significant differences on volume of intraoperative blood loss, urine and infusion among three groups (P>0.05). There was no patient transfused in group A and B, but there were three patients transfused in group C.Conclusion: 1. This study confirmes that the new generation of artificial colloid Voluvencan effectively maintain the hemodynamic in the state of stable. Its volume expansion effect and maintaining time is similar to HES and is more reliable than that of crystalloidal fluid.2. Mild-degree AHH with Voluven have no obvious harmful effect on hemodynamics, blood coagulation, constitution oxygenation, renal function, and can improve immune function. It can be safely used in the geriatric patients without significant dysfunction of cardiopulmonary and normal coagulation and renal function.3. When patients have been practiced mild-degree AHH with Voluven or HES, Voluven is less effect on coagulation function than HES. So it's a more ideal plasmatic substitute that is used in preoperative AHH.4. Cardiovascular function must be closely monitored and the velocity and dose of infusion must be also closely controlled when AHH was administrated on geriatric patients to avoid the side effect of cardiopulmonary and other physiological function for the overloading of circulation.5. The procedure of preoperative AHH is convenient and can decrease the change of blood contamination, the price is lower and the effect of saving blood is reliable. Therefore, AHH may be as a feasible, safe and effective method of saving blood to apply in clinic.
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