Effect Of Hes 130/0.4 As A Priming Solution In Cardiac Surgery

Background Before the cardiopulmonary bypass circuit,the oxygenator and the circulating pipe should be pre-filled with liquid or blood.Early priming solution was all fresh blood with heparin,which was later replaced by the blood with citric acid.Whole blood priming caused a lot of blood waste,as well as the risk of infection with blood-borne diseases.In addition,the phenomenon of stasis will be found in the microcirculation when using the blood to prime,clinical practice and experimental studies found that complete blood priming can cause acidosis.In the early 1960 s,the doctors started to use 5% glucose or normal saline priming in clinical.At present,there are so many priming solutions,the most commonly crystal liquid is lactated ringer's solution or acetic acid Ringer's solution,in order to avoid colloid osmotic pressure is too low,we always need to add some colloidal solution,mainly starch and gelatin.Gelatin artificial colloids have little effect on coagulation,but prone to allergic reactions,once occurring,can have serious consequences for patients and are therefore rarely used.The volume expansion effect of starch artificial colloid is very well,they have less allergic reactions,but have harmful effect on the kidney function and coagulation function.This study will assess the risk and benefit of hydroxyethyl starch as an extracorporeal circulation priming solution and provide guidance for cardiopulmonary bypass in future.Objectives Explore liver,kidneys,lungs and coagulation function of the adult patients who are undergoing heart surgery when the cardiopulmonary bypass circuit is primed with 130/0.4 hydroxyethyl starch solution.To observed the incidence of complications and mortality after cardiopulmonary bypass,and explore the influences of modified hydroxyethyl starch 130 / 0.4 on prognosis.Methods We used a prospective,randomized,single-blind and controlled study.Four hundred and eighty-one patients were prospectively studied.The patients were randomized in-to two groups.First group received a balanced electrolyte solution and the second group received hydoxyethyl starch 130/0.4 as prime solution.Coagulation function: arterial blood samples was collected at different points in both twogroups: before surgery,24 h after surgery.(APTT),thrombin time(TT),fibrinogen(FIB),coagulation factor R,fibrinogen K,platelet function MA,fibrinolytic system LY30 were measured in collected samples.Organ function: Respectively,before the surgery,postoperative 24 h and 5days,creatinine Clearance(Ccr)were calculated and venous blood samples were measured in many parameters: aspartate transaminase(AST),alanine transaminase(ALT),Total bilirubin(TBIL),blood ureanitrogen(BUN),serum creatinine(CR),cystatin c(Cys C);and calculated the((RI),(OI)and(TI)after anesthesia induction,end of CPB and operation.Postoperative situation: At the beginning of entering the ICU after operation,mechanical ventilation time and ICU treatment time,length of hospital stay were collected.The number of patients with complication was recorded.Symptoms of complications include infection,secondary thoracotomy,arrhythmia,secondary ICU,neurological complications,secondary tracheal intubation,incision healing and the use of temporary pacemaker,and death cases were recorded before leaving hospital.Results Coagulation function: There was no significant difference in TT,FIB and APTT between the two groups before and after operation(P> 0.05)and at the normal reference level.Compared with T0,the TT of both groups was shortened at T1 time(P <0.05),while FIB increased at T1 time(P <0.05).APTT in CON group was shortened at T1 time(P <0.05),but APTT in HES group were no significant difference before and after operation(P> 0.05).There were no significant differences in LY30,R,K and MA between the two groups before and after operation(P> 0.05).Compared with T0,LY30 and R were significantly increased in both groups(P <0.05)at the 24 h after operation(P <0.05),and MA decreased at 24 h after operation(P <0.05).Organ function: Renal function There were no significant differences in Cys C,SCr,BUN and Ccr between the two groups(P> 0.05).At the T1 time,the Cys C,SCr and BUN of the HES group were higher than those of the CON group(P <0.05).The Cys C in the HES group was also higher than that in the control group(P <0.05).Compared with T0,at the T1 time,the Cys C,SCr and BUN of the two group were increased(P <0.05),while Ccr decreased(P <0.05).Compared T2 time with T0 time,the SCr of both groups decreased and the Ccr increased(P?0.05),but compared with the time of T0,the BUN of the two groups is still higher at the T2 time(P?0.05).Liver function There were no significant differences in AST,ALT and TBIL between the two groups at the time of T0,T1 and T2(P> 0.05).Compared with the time of T0,the AST,ALT and TBIL were all increased at the T1 and T2 time(P <0.05).Lung function At the time of T5,the CL of HES group was higher than that of CON group(P <0.05).Compared with the time of T4,the RI of the T5 and T6 time increased and the OI was decreased in the two group(P <0.05).The CL of the HES group at the T5 time was higher than that of the T4 time,but there was no significant difference(P >0.05),while the CL of the CON group decreased(P <0.05).Compared with the time of T4,the both groups' CL increased at the T6 time.Postoperative situation: The mechanical ventilation time,usage of plasma and furosemide and drainage after surgey were significantly higher in the HES group than in the CON group(P <0.05);the patients with new incidence of arrhythmia is 14(2.9 %),3 cases(1.2%)in CON group,11 cases(4.7%)in HES group,and the new incidence of arrhythmia in HES group was significantly higher than that in CON group(P <0.005).Conclusion The results of this study show that hydroxyethyl starch 130 / 0.4,as an extracorporeal circulation priming solution,is beneficial to the recovery of liver function and lung compliance in patients undergoing cardiac surgery compared with the crystal solution.It has adverse effects on the renal function,but the effects are transient and reversible.but its adverse effects on coagulation lead to increase the dosage of plasma and the postoperative drainage.