Blood Protection Of Acute Normovolumic Hemodilution Combined With Aprotinin In The Elderly Patients Undergoing Replacement Of Knee Joint

Objective: The purpose of this study was to evaluate the effectiveness and safety of acute normovolemic hemodilution(ANH) combined with aprotinin in the elderly patients undergoing replacement of knee joint. Methods: Sixty ASA â…  -â…¡ patients of both sexes,aged between 65-75yr undergoing elective replacement of knee joint were enrolled in this study.Their preoperative HCT>35%.The operations were performed under combined spinal-epidural anesthesia.The patients were randomly divided into 4 group: â…  : control group,â…¡: aprotinin group, â…¢: ANH group, â…£: ANH combined with aprotinin group,with 15 cases in each group.Before anesthesia Ringer's solution 7ml · kg^-1was infused to compensate for preoperative floid restriction after midnight. Group â…  : infused with Ringer's solution at a routine rate of 10ml · kg^-1 · h^-1.Group â…¡ : aprotinin 10×10⁵IUwas give before operation and another dose of aprotinin 10×10⁵ IU was continuously infused during operation, only Ringer's solution was administered routinely. Group â…¢: 15ml · kg^-1 6%HES(200/0.5)were infused at a rate of 50ml · min^-1 .At the same time 10% blood volum(BV) was removed through radial arter. blood volume was calculated according to following formula: BV(ml) =weight(kg) ×70 ml ·kg^-1(male)or×65 ml ·kg^-1 (female).The removed blood was reinfused in 24 hours after operationt. Group IV: hemodilution method is togetherGroup III. The operation method of aprotinin is together Group II . Group III and GroupIV, infused with Ringer's solution at a routine rate after hemodilution .ECG,BP,CVP and SpO2 were continuously monitored throughout operation.Central venous blood samples were taken for Hb,Hct,PLT,PT,INR,FIB,APTT,blood sugar and noradrenaline , arter blood samples were taken for arterial blood gas at before anesthesia(Tl),after anesthesia(T2),after hemodilution(T3),the start of operation(T4), the end of operation(T5),24hrs after operation(T6), 48hrs after operation(T7).The volume of infusion, blood adopt ,blood transfusion,blood loss and urine were recorded during operation.Results: 1 The vital signs were fairly stable during preoperative in four groups. In Group Illand GroupIV CVP increase significantly after hemodilution .but within normal range .There was significant in CVP between hemodilution groups and control group (P<0.05) .As compared with MAP Group I and Group II ,the hemodynamic patameters less changed. 2 Blood gas level were within normal range in four groups.There was no significant in four groupsC P<0.05) .3 There was no significant in blood coagulation funtion between Group II and Group I (P>0.05) . In Group Illand GroupIV compared with Time Point Tl at Point T3 and Point T5 APTT PT were significantly longer and INR was significantly greater,FIB was significantly lower,but normal mostly. 4 moderate hemodilution was achieved while in Group Illand GroupIV. Hb,Hct: GroupIV>GroupIII= Group II > Group I after operation. 5 .There was no significant in blood sugar and noradrenaline between GroupIIIandGroup I (P>0.05). compared with Time Point Tl at Point T5 noradrenaline was significantly higher in GroupIIIand Group I (P<0.05).6 In Group II and GroupIV the volume of blood loss reduced significantly. The volume of blood transfusion: GroupIV