| Objective:Using FloTrac/Vigileo system to investigate hemodynamic changes of the senile patients with coronary heart disease(CHD) during anesthesia induction period by infusing hydroxyethyl starch130/0.4before anesthesia induction. Discussing the safety and efficacy that implement Acute Non-normovolemic Hemodilution (ANIH) to senile patients with CHD during anesthesia induction period, providing clinical bases for the reasonable implement of ANIH for such patients stable through the critical period.Methods:Randomly select twenty senile patients with CHD undergoing non-cardiac surgery, aged60-80years old, weight50-80kg. The patients were randomly divided into two groups:control group(group C, n=10), ANIH group(group A, n=10). Intramuscular injections of Atropine0.5mg, Phenobarbital sodium100mg were applied to each group30minutes before the surgeries. A left radial artery catheter was inserted and connected to FloTrac under local anesthesia, meanwhile a right internal jugular vein was punctured and connected to the pressure transducer after entering the operation room. Continuous monitoring Hart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), central venous pressure(CVP), pulse oxygen saturation(SpO2), cardiac output(CO), cardiac index(CI), stroke volume(SV). Patients in group A were infused10ml/kg hydroxyethyl starch130/0.4(Voluven) in30minutes, group C were infused normal saline(NS) by normal does. Patients in both groups were induced with midazolam0.05ml/kg, sulfentanyl0.8ug/kg, cisatracurium0.2mg/kg and etomidate0.3mg/kg. Recording the monitoring indicators as before when the patients were calm(TO), finish ANIH(Tl), before intubation after anesthesia induction(T3), intubation in real-time(T4) and10minutes after intubation(T5).Exclusion criteria:hepatic and renal dysfunction, severe arrhythmia, aortic insufficiency, disturbances of blood coagulation and malignant anemia.Results:There were no statistically significant differences in two groups in physical status, age, weight, height, body surface area, ejection fraction(EF), et al(P>0.05). For group A, HR is stable before and after ANIH, CVP gradually increased following with the increasing of infusion, but they were all within normal limits, CO also increasing. With the both groups, HR was significantly slower after induction compare with the baseline. After induction, MAP, CO and SV are significantly decrease with two groups. Compare with group C, theâ–³MAPã€â–³CO andâ–³SV in group A are statistically significant differences(p<0.05). The major adverse cardiac event in group A is less than group B.Conclusion:Infusing colloid Voluven10ml/kg before anesthetic induction in no-cardiac surgery is safe with senile CHD patients. After ANIH, the decrease of MAP, SBP, CO, SV were lower than group C. Comparing with group C, the hemodynamic were more stable and the major adverse cardiac event were significant lower in groupA. |
