Effects Of Acute Hypervolumic Hemodilution With 6% Hydroxyethyl Starch(130/0.4)on Glycometabolism In Patients With Posterior Lumbar Decompression And Bone Graft Fixation

Objective: To investigate the effects of acute hypervolumic hemodilution(AHH) with 6% hydroxyethyl starch(130/0.4)on glycometabolism in patients with posterior lumbar decompression and bone graft-fixation.Methods: Sixty ASA I~II patients scheduled for elective surgery were randomly divided into three groups: control group (groupA, n=20), Ringer's solution group (groupB, n=20) and voluven group (groupC, n=20). In group B and C, 15 ml·kg-1 Ringer's solution or voluven were infused respectively in 20~30min after induction of anesthesia. HR, MAP, SPO2 and CVP were continuously monitored in three groups. The amount of blood lost, blood transfusion, errhysis of 24h were observed. Also, length of stay in hospital, complication and VAS score were recorded. Blood samples were taken and the level of Hb, Hct, lactic acid, PH, electrolyte (K+,Ca2+,Na+ ), glucose (glu), cortisol (cor), glucone (gln) and insulin (ins) were examined at different time points: before the AHH (T1),AHH finished immediately (T2), immediate post operation (T3), and 2 hours post operation (T4). Also the HOMA-insulin resistance index (HOMA-IRI) and insulin sensitivity index (ISI) were calculated.Results:(1) Compared with the group A and B, the hemodynamic of group C was more stable. The concentrations of Hb andHct decreased slightly in group C at post operation compared with other two groups (p<0.05).There were no significantly changes of PH valueand electrolyte (K+,Ca2+,Na+ ) among three groups. (2) There were no significant changes of blood lost, errhysis of 24 h post operation, but the amount of blood transfusion in group A and B was larger than group C. (3) In group C, glu, cor, gln, ins and IRI elevated at a less degree than that observed in group A and B.ISI decreased slightly in group C at post operation compared with other two groups. (4) In group A and B, the length of stay in hospital were much longer than group C, also the complication was much more severity than group C.Conclusions: Implemented AHH with voluven before surgery can reduce posterior lumbar decompression and bone graft in patients with the concentration of stress hyperglycemia, cortisol, glucone and insulin resistance.