| Objective:To observe the effect of acute hypervolemic hemodilution(AHHD) with hydroxyethyl starch130/0.4on blood circulation of thetransplanted free flap.Methods:Fifty patients undergoing lower extremity free flap repairsurgery, were randomly divided into2groups (n=25) and group A receivedintravenous infusion of6%hydroxyethyl starch130/0.4and group B receivedcompound sodium chloride injection before operation to decrease Hct to30%in30minutes. During the operation, only compound sodium chloride injectionwas used. Anesthesia method was combined spinal-epidural anesthesia.Hemorheology index was measured before and after operation. After vascularanastomosis, the capillary filling time, skin flap tension，skin color, skintemperature difference of transplanted skin of the2groups were recorded andcompared. Dosage of papaverine, the vasospasm rate, re operation rate andsurvival rate of free skin flap in two groups were recorded.Results:There was no significant difference between the2groups ofpatients before expansion in each indexes. At the beginning of operation (T2),CVP in voluven group (group A) was obviously higher than that in controlgroup (group B), P <0.05. The whole blood high shear reduced viscosity,whole blood low shear reduced viscosity, hematocrit, erythrocyte aggregationindex was significantly lower than pre-hemodilution and B group, erythrocytedeformation index in A group was higher than that in control group andpre-hemodilution. At the end of operation (T3), CVP, MAP of two groups is stillhigher than pre-hemodilution (P <0.05). The capillary filling time was significantly lower in group A than that in B group, skin temperature werehigher in group A than that in B group. The dosage of papaverine was lower ingroup A than that in group B.Conclusions: Acute hypervolemic hemodilution with6%hydroxyethylstarch130/0.4can improve the blood circulation of transplanted flap helps torelease the vascular crisis and contribute to the survival of transplanted flap. |
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