| Objective:This study was to explore acute hypervolemiche modilution combined with intraoperative salvage autotransfus in patients ndergoing general anesthesia for spinal surgery, the effects on oxygenation and homeostasis, the difference of intraoperation blood loss, volume of blood transfusion, volume of autolougustransfusion, volume of variant blood transfusion, discuss the safety and efficacy of two blood-protect technique combined applicatied,it is necessary to blood-protect in reason and maintenance the perioperative homeostasis of patients.Methods:This was a randomized control design.General Anesthesia for sixty patients, ASAI-Ⅱ, scheduled for internal fixation of spinal were divided randomly in to twogroups:the observe group (n=30) and the comparison group (n=30). Specimens of plasma were collected irrespectively at fourtimepoints:before AHH(T1), after AHH (T2), before blood transfusion (T3), after blood transfusion(T4).ScvO2,CI,DO2,VO2,O2ER were calculated with Vigileo monitor, blood gas analysis were taken for PH,PO2,BE,Hb,Hct and concentration of Lac,Na+,K+ Ca2+. The preoperative changes of oxygenation and acid-basebalance,electrolyte,volume of bloodloss,volume of blood transfusiono。Volume and rate of variant blood transfusion compared between two groups.The clinical factors were compared between the two groups. Statistics treatment:The measure ment data was expressed as"x±s". The measurement count was expressed"X2", and using Indepentdent-Samples T Test program and Repeated Measures ANOVA program of SPSS 17.0 software to analyze it.When the value of "P" is lower than 0.05, it has statistical significance.Results:Noanemia,blood coagulation abnormality,infection,hepaticcoma and kidney function hurt oranother postoperative complications, all patients recovery in thestudy.1.General Clinical Informati on There were no significant differences of the gender,the age,the body mass,operation method,preoperative combination disease and operation time betweent the two groups(P>0.05).2.Blood loss of the observe group was (955.00±278.33) ml, And the comparison groupwas(988.67±240.20)ml, There were no significant differences (P>0.05). volume of blood transfusion of the observe group was (422.33±231.14) ml,rate of variant blood transfusionwas (10%) both lower than the patients in the comparison group (P<0.05).3.ScvO2 changed with the time factor and showed significant difference between the two groups (P<0.05).Compared between the two groups, there were no statistically significant defference of ScvO2 at T1,T2 and T3 (P>0.05). ScvO2 at T4 (80.50±2.764)% in the observe group were significantly higher than the comparison group (77.27±3.073)%(P＜0.05). ScvO2 at T3 (76.23±3.875)% in the observe group was the lowest(P<0.05).In the comparison group, ScvO2 at T1, T2 were both higher than T3 or T4 (P<0.05).4.Compared between the two groups, DO2 at T2 time points(498±63) [ml/(min-1·m2)] was significantly lower in the observe group than that in the comparison group (448±79) [ml/(min-1·m2)](P<0.05).Compared with in the each group, DO2 was the highest at T4 (554±96), (546±91) [ml/(min-1·m2)],and was the lowest at T3 (387±44),(351±89) [ml/(min-1·m2)]in the both group.In the each group, DO2 was higher at T2 than T1(P<0.05).VO2 in the both group was thelowest at T4 (127±46),(133±61) [ml/(min-1·m2)](P<0.05).O2ER was higher in the comparison group at T3,T4(29±6),(30±7)% and lower in the obeserve group at T4 (P＜0.05).Compared between the two groups or compared with in the each group, there were no Statistically significant defference of Ciatthe four time points(P>0.05)5.Compared between the two groups, concentration of Lac at T2 and T3 were significantly lower in the obeserve group (1.1±0.2)%(1.1±0.3) (mmol/L) than the comparison group (1.2±0.1),(1.4±0.3) (mmol/L) (P＜0.05). Compared with in the each group, concentration of Lac had significant difference at the four points (P＜0.05), it was thelowest atT4 (0.9±0.2),(1.0±0.4) (mmol/L), and was the highest at T3 in the both group(P<0.05).Changes of Hb were the same as Hct. Compared between the two groups, at T2 Hb (101.5±16.5) g/L,Hct (31.4±4.2)% was significantly lower in the obeserve group than thecomparison group(P<0.05).Compared with in the each group, it was the lowest at T3 (94.2±9.1) g/L,(92.8±7.2) g/L,(28.4±2.2)%,(27.4±2.3) %and was the highest at T1 (130.5±11.5) g/L,(130.1±12.9) g/L,(39.1±4.2) %,(38.6±4.8)% in the both group(P<0.05).Changes of PO2 were the same as PH. Compared between the twogroups, PO2 and PH atT4 (40.9±2.3),(7.33±0.08) was significantly higher in the obeserve group than the comparison group(P<0.05). Compared with in the each group,it was the highest at T4 in the obeserve group (P<0.05) and was no significantly difference in the comparison group at the four points(P> 0.05)Compared between the two groups, BE at T4 was significantly higher in the obeserve group (2.2±1.08) than the comparison group (1.6±1.19) (mmol/L) (P<0.05). Compared within the each group it was the lowest at T3 in the obeserve group (1.7±1.37) (mmol/L) (P<0.05),and at T4 in the comparison group(P<0.05).6.Electrolyte Comparedbetween the twogroups or compared with in the each group there were no statistically significant defference of concentration of Na+at the four time points(P> 0.05)Compared between the twogroups, K+ at T2 and T4 was significantly lower in the obeserve group (3.71±0.26),(3.64±0.36) (mmol/L) than the comparison group (3.90±0.32),(4.33±0.26) (mmol/L) (P<0.05).Compared with in the each group, Concentration of K+had significant difference at the four points, it was the lowest at T4 inthe obeserve group(P<0.05)and highest at T4 in the comparison group(P<0.05).Compared between the twogroups, there were no statistically significant defference of Ca2+at the four time points(P> 0.05), compared with in theeach group, it was the lowest at T4 (0.90±0.15),(0.87±0.13) (mmol/L) in the both groups (P＜0.05).Conclusions:1. Acute hypervolemiche modilution combined with in traoperative salvage autotransfus have not blight on oxygenation. Intraoperative oxygen supply and need relation was balance than the comparison group. It can be safey used in patients undergoing general anesthesia for spinal surgery.2.When acute hypervolemichemodilution combined withi ntraoperative salvage autotransfus in patients undergoing general anesthesia for spinal surgery, the lowest of Hb was (94.2±9.1) g/L,the lowest of Hct was (28.4±2.2)%,which were both in the norm rang after operation. Acute hypervolemichemodilution combined with intraoperative salvage autotransfusin can significant reduce volume of variant blood transfusion, rate of varian tblood transfusion, and take on significantly and safely protection of blood.3.In acute hypervolemiche modilution combined with intraoperative salvage autotransfus, concentration of Na+,K+,Ca2+ was in the norm range, but after blood transfusion, concentration of K+was lower than preoperation.During the operation, we must enhance the monitoring of concentration of K+ and supply kalium perioperative.4.Compaired allogenictransfusion, it was acid-basebalance at acute hypervolemic hemodilution combined with intraoperative salvage autotransfus and no ad verseeffectsonhomeo stasi s. |
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