Effects Of Acute Hypervolemic Hemodilution On Cerebral Oxygen Metabolism In Patients Undergoing Laparoscopic Radical Prostatectomy

Background:With the increased incidence of prostate cancer,large amount of patients are received radical prostatectomy annually who often need allogeneic blood transfusion when large bleeding is happened during operation.Acute hypervolemic hemodilution(AHH)has been regarded as one of the most common perioperative blood protection management in clinic mainly due to its quick effect on increasing blood volume,little effect on circulation and beneficial effect on cerebral oxygen metabolism.Studies have founded that AHH could decrease the volumes of allogeneic blood transfusions and be safely applied to routine radical prostatectomy.Nowadays,with the development of laparoscopic technology,laparoscopic radical prostatectomy has become more common in clinic which needs carbon dioxide pneumoperitoneum and Trendelenburg position that may have an impact on circulation stability and cerebral oxygen metabolism.However,as we know,there is no study reporting the effect of AHH on patients with laparoscopic radical prostatectomy.Therefore,we intend to study the effects of AHH on hemodynamics and cerebral oxygen metabolism in patients undergoing laparoscopic radical prostatectomy,and to discuss its feasibility and security,in order to provide evidence for saving blood and protecting cerebral function in clinic.Objective:1.To discuss the effects of AHH on hemodynamics in patients with laparoscopic radical prostatectomy and further to investigate if allogeneic blood transfusion could decrease as a result.2.To discuss the influence of AHH on cerebral oxygen metabolism in laparoscopic radical prostatectomy.Methods:Sixty patients receiving laparoscopic radical prostatectomy were randomly divided into control group or observation group(AHH group).Patients in AHH group were received AHH with hydroxyethyl starch and Ringer’s lactate solution(1:1)of 20ml/kg by 50ml/min,and patients in control group were received routine infusion with Ringer’s lactate solution 6～8ml/min.Carbon dioxide pneumoperitoneum was designed as 12 mmHg and patients’ position was 30° Trendelenburg position.Blood from the artery and the ball portion of the internal jugular vein was collected at different time points:before AHH(T1),10 min after AHH(T2),10 min(T3)and 60 min(T4)after starting pneumoperitoneum and Trendelenburg position,10 min after stopping pneumoperitoneum and horizontal position(T5)for blood gas analysis.We also calculated oxygen content of arterial(CaO2),the hall portion of the internal jugular vein(CjvO2),cerebral oxygen uptake rate(CERO2),the difference between arterial and internal jugular vein bulbar blood oxygen(Da-jvO2)and the difference between the arterial and internal jugular vein bulbar blood lactate(VADL).Oxygen saturation of internal jugular vein bulbar(SjvO2),the pressure of internal jugular vein(JVP)and central vein(CVP),mean blood pressure(MBP),heart rate(HR),bleeding volume,the incidence and volume of blood transfusion were also recorded.Postoperative cognitive dysfunction(POCD)was also assessed by mini-mental state examination on one day before surgery,and one day,three days and seven days after surgery.Results:1.The effects of AHH on hemodynamics and allogeneic blood in laparoscopic radical prostatectomy.The incidence of allogeneic blood transfusion and average transfusion volume of control group were significant higher than those in AHH group(p<0.05),but there were no significant differences between the two groups in aspects of POCD,MBP,CVP,HR and JVP.In addition,the CVP and JVP at T3 and T4 were significant higher than those in other time points in each group.2.The influence of AHH on cerebral oxygen metabolism in laparoscopic radical prostatectomy.The levels of Da-jvO2 and CERO2 at T3 and T4 were significantly lower than those at T1 and T2 in each group,while in AHH group,the levels at T2～T5 were significantly lower than those in control group(p<0.05).Moreover,the levels of SjvO2 at T3 and T4 were significantly higher than those at T,and T2 in control group.But in AHH group,the levels of SjvO2 at T3 and T4 were significant higher than that at T1,,those at T3 and T4 were significantly higher than that at T2 And the levels of Sjv02 at T2～T5 in AHH group were significantly lower than those in control group.There was no significant difference at any time points between the two groups regarding VADL(p>0.05).Conclusions:1.The application of acute hypervolemic hemodilution in patients undergoing laparoscopic radical prostatectomy can enhance the stabilization of hemodynamics and decrease the volume of allogeneic blood transfusion.2.Acute hypervolemic hemodilution can increase the oxygen providing of brain and decrease the oxygen consumption of brain in patients undergoing laparoscopic radical prostatectomy.