Effects Of Acute Hypervolemic Hemodilution Combined With Controlled Hypotension On Renal Function In Elderly Patients Undergoing The Radical Operation Of Tongue Carcinoma

Objective: To investigate the effects of acute hypervolemic hemodilution(AHH) combined with controlled hypotension(CH) on renal function in elderly patients undergoing the radical operation of tongue carcinoma.Methods: Forty ASAⅠorⅡpatients aged 60-76 ys undergoing the elective radical operation of tongue carcinoma were randomly divided into 2 groups(n=20 each): groupⅠreceived AHH combined with CH; groupⅡreceived CH alone. SBP, DBP, MAP, HR and CVP were continuously monitored and recorded before operation(T0), 1h after CH(T1), 1h after termination of CH(T2) and the end of operation(T3)and hemoglobin(Hb) concentration and hematocrit(Hct) were determined at T0 and T1. Serumα1-MG was determined at every point and concentrations of BUN and CR were determined at T0 and T3. During CH, urine volume was measured and Fromme score of surgery field was assessed. Intraoperative blood loss and transfusion were measured.Results: In groupⅠCVP at T0 was lower than that at T2 or T3, but in groupⅡCVP at T3 was higher than that at T0(P<0.05). There was no significant difference in haemodynamic index between the two groups. Hb and Hct at T1 were lower than that at T0 in the two groups. Hb and Hct at T1 in groupⅠwere lower than that in groupⅡ(P<0.05). In groupⅠserumα1-MG at T3 was higher than that at T0(P<0.05). CR at T3 in groupⅠwas lower than that in groupⅡ(P<0.05). There was no significant difference inα1-MG between the two groups. The urine volume during CH in groupⅠwas higher than that in groupⅡ(P<0.05). There was no significant difference in Fromme score of surgery field and blood loss between the two groups. But the blood transfusion in groupⅠwas lower than that in groupⅡ(P<0.05).Conclusion: AHH combined with CH can maintain the stability of haemodynamics and reduce blood transfusion in elderly patients undergoing the radical operation of tongue carcinoma. Compared with CH, this method has no adverse impact on perioperative renal function in elderly patients and its protective effect remains to be further studied.