Acute Hypervolemic Hemodilution Combined With Controlled Hypotension Induced By Urapidil

Objective To observe the effects of acute hypervolemic hemodilution(AHH) combined with controlled hypotension induced by urapidil on hemodynamics,tissues perfusion,blood loss and blood transfusion in spinal surgery and assess the safety and efficacy of its clinical application.Method Forty-eight ASAⅠ～Ⅱpatients undergoing elective operation of spinal surgery under intravenous-inhalational anesthesia were chosen to join in the study.Patients were randomly divided into controlled group(â… ,n=16),AHH group(â…¡,n=16) and AHH combined with controlled hypotension induced by Urapidil group(â…¢,n=16).Neither AHH nor controlled hypotension was performed in groupâ… ,AHH was performed by intravenous infusion of 6%HES(130/0.4) 15ml·kg^-1 in 30min in groupâ…¡and groupâ…¢after tracheal intubation,at the same time of AHH,controlled hypotension was performed by intravenous infusion of urapidil in groupâ…¢.Mean aortic pressure(MAP),central venous pressure(CVP),heart rate(HR), haematocrit(Hct),hemoglobin(Hb) and blood lactate(Lac) were recorded before hemodiluion(T₀, after induction of anesthesia),30min after hemodilution(T₁,in groupâ… ,the time point was 30min after induction of anesthesia),and 1h after hemodilution(T₂,in groupâ… ,the time point was 60min after induction of anesthesia).Urine output,blood loss,and blood transfusion of each operation were recorded.Ratio of blood transfusion was calculated.Results Changes of hemodynamics:There was no significant difference in HR within the same group and between groups(P＞0.05),CVP increased significantly from baseline after AHH in groupâ…¡(P＜0.001),MAP decreased significantly from baseline after CH in groupâ…¢(P＜0.001).Changes of hemodilution:Hb and Hct decreased significantly from baseline after AHH in both groupâ…¡and groupâ…¢(P＜0.001).Hb and Hct in groupâ…¡and groupâ…¢was significantly lower than in group B at T₂,T₃(P＜0.001).There were no significant differences between groupâ…¡and groupâ…¢(P＞0.05).Changes of blood lactate:There was no significant change in blood lactate within the same group and between groups(P＞0.05) Comparision of blood loss,blood transfusion,urine output and ratio of blood transfusion:Both blood loss and blood transfusion of groupâ…¢were decreased significantly compared with groupâ… and groupâ…¡(P＜0.01,P＜0.05 ).Ratio of blood transfusion was significantly different between groups(P＜0.001).Urine output was significantly higher in groupâ…¡andâ…¢than in groupâ… (P＜0.01)Conclusion AHH combined with controlled hypotension induced by urapidil can make hymodynamic stable,decrease blood loss significantly,reduce transfusion of homologous blood.In spinal surgery,when blood loss is from 800ml to 1200ml,AHH combined with controlled hypotension induced by urapidil could be safe and efficient.