Comparing The Effects Of Coagulation In Acute Hypervolemic Hemodilution Of Different Hydroxyethyl Starch

Background and Objective Blood losing caused hypovolemia has become a common clinical problem in surgical operation, complications of allogeneic blood transfusion caused by the gradual increase , clinical practice shows that in addition to the common cause of infectious disease transmission, it can also cause severe immune response and immune suppression, such as increased rates of cancer recurrence, etc, this makes many people unwilling to accept blood transfusions; and the amount of blood for clinical use also increased , the blood supply can not meet using, so saving blood become an important issue in medical research .Preoperative hemodilution (Hemodilution, HD) has become an effective clinical blood conservation methods, HD is to make the blood relative or absolute reduction in the vessels, lower blood concentration in order to reduce the loss of red blood cells. Today's popular methods of hemodilution with acute hemodilution (Acute Normovolemic Hemodilution, ANH), and acute Normovolemic hypervolemic hemodilution in acute hypervolemic hemodilution (Acute Hyperlemic Hemodilution, AHH) is commonly used in blood conservation, ANH is After induction of anesthesia before operation, according to the patient's hematocrit and body weight and estimated blood loss, collectes a certain amount of blood of the patients ,at the same time to transfuse the same amount of crystalloid infusion and (or) colloid, to maintain the basic constant of the patient's blood volume, lower hematocrit, so that make a certain hemodilution . However, such hemodilution method is time-consuming and money-consuming, but it will be also increase the chance of contamination, thus limiting its clinical application. AHH applications increased in recent years, that is, after induction of anesthesia before the operation input a certain amount of colloidal solution, do not collected blood from the patients ,so the blood volume increases, in order to the blood reaches a certain level of dilution, the patient's total blood volume was significantly higher than that of AHH before, increase their tolerance to blood loss, and play a role in blood conservation, and its simple operation, low cost, compared with ANH and other hemodilution method has more advantages. HD is divided generally by the extent of dilution according to the Hct in the large vessels, Hct of 0.45 to 0.3 for the mild dilution, dilution of 0.3 to 0.2 as moderate, severe dilution of 0.2 ~ 0.1. General blood-thinning boundary is Hct20%, Hb6 ~ 7g/dl, generally Hct to 20 ~ 30%, and that is moderate hemodilution.The body through a variety of mechanisms to increase cardiac output after HD, such as excitement sympathetic,speed up the redistribution of blood of tissues and organs to ensure the ability what the body to use oxygen and oxygen supply to vital organs. Studies have shown that mild,moderate hemodilution on cerebral blood flow (CBF) greater, than that in the degree of arterial oxygen content decreased, and even increased. Of the heart with normal heart function, can withstand all forms of HD, but with age, this tolerance will decrease. HD also with controlled hypotension (CH) in combination, usually with the CH and AHH, its advantage is to avoid overloading of the heart that caused the adverse effects of cardiac function, but the application of certain organs of CH compensatory mechanism weakening ,effects the organ blood supply, it should be according to the condition of the patients various organs, hold indications of AHH joint CH strictly.HD will be used to artificial plasma substitutes, the ideal what addition to expansion and dilute functions it should also has the blood oxygen carrying capabilities, but the ideal is still at studying stage. Clinically, mostly for HD is colloidal solution, in proportion with crystalloid infusion.A new generation of artificial plasma substitutes ,medium molecular weight, low-substitution of 6% hydroxyethyl starch (6% HES130/0.4), expansion works well, maintain the cycle stability for a long time ,little effect on blood coagulation, can effectively improve microcirculation and oxygen supply after infusion tissue perfusion, and a unique vascular leakage sealing effect, and can reduce the inflammatory response, favorable clearance kinetics, less tissue accumulation, less adverse reactions, it is the ideal substitutes used in clinical protection of hemodilution and blood plasma relatively. Imports 6% hydroxyethyl starch (Voluven) proved to be more safely and effectively used in AHH in literature. The recommended dose 50ml/kg of Voluven, blood loss and transfusion does not increase, no accumulation, a stable and high rate of renal excretion.Europe in January 2004 approved for using for infants and young children, well known that safety of its clinical application. Commonly used in clinical 6% hydroxyethyl starch is measured into the import and domestic , may be due to the production process and (or) difference of raw materials, that made 6% hydroxyethyl starch (JingHua) and imports of 6% hydroxyethyl starch(Voluven) adverse reactions on the body, hemodynamics and coagulation function is whether similar to the lack of further study. Therefore, the purpose of the experiment that comparison of domestic and imported 6%HES in AHH on coagulation whether same, as well as add to another choice of plasma substitutes .Methods 30 patients undergoing radical gastrectomy , 11 males and 19 females, aged 45-60 years old, weighing 55-75kg. ASAⅠ~Ⅱ; preoperative Hb≥110g / L, Hct≥30%; no significant liver and kidney dysfunction; no diseases history of hypertension or other heart disease; no coagulation disorder; no water and salt metabolism. There were randomly divided into domestic HES (HESJ) group and the import of HES (HESV) group, 15 cases each.After enter the operation room, monitoring blood pressure (BP), heart rate (HR), pulse oxygen saturation (SpO2) ,in the left radial artery puncture under local anesthesia, monitoring of invasive blood pressure (IBP). Prepare for anesthesia, all patients were treated with general anesthesia, compound intravenous and inhalation anesthesia ,before induction inject penehyclidine hydrochloride 1mg. Induction of anesthesia: followed by intravenous infusion midazolam 0.03mg/kg, etomidate 0.2mg/kg, cis-atracurium 0.15mg/kg, sufentanil 0.4μg/kg, supply oxygen with mask in order to remove N2 ,3-5min to endotracheal intubation, then put through anesthesia machine and mechanical ventilation, tidal volume8-10ml/kg, respiratory rate 12bpm. Anesthesia maintenance : intraoperative inhaled sevoflurane 1.2-1.5MAC, intermittent to give cis-atracurium,sufentanil and propofol, to maintain the appropriate depth of anesthesia. Then at right internal jugular vein to venepuncture to monitor central venous pressure. When anesthesia steady within 40 minutes before operation, start at the rate of 30 ml / kg.h random input of two different HES, measured before infusion (T0), infusion 20 min (T1), infusion40 min (T2) and AHH after 20min (T3), blood pressure (BP), central venous pressure (CVP), heart rate (HR),pulse oxygen saturation (SpO2) and blood hemoglobin (Hb), mean hemoglobin hematocrit (Hct), platelet count (Plt) and prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT).The results It was analyzed by SPSS11.0 statistical software, measurement data as mean±standard deviation ( x±s) indicated, P <0.05 was considered statistically significant. The two groups before and after the hemodynamic changes remained general stable in the AHH, at AHH completed 20 min, and compared to before AHH, there is no allergic reaction, two among groups were increase significantly CVP (P <0.01), but the results within the normal range; Hb, Hct, Plt decreased (P <0.05), coagulation parameters except TT showed no significant change with control group, compared to two other control group were significantly prolonged (P <0.01), but the three indicators among groups had no statistical significance ( P> 0.05).Conclusions Domestic 6% HES130/0.4 (JingHua)as well as the import 6% HES130/0.4 (Voluven) on expansion, safe for AHH, improve circulation, hemodynamic stability, reduce allogeneic blood transfusion, effect on blood coagulation were mild, it is a safe and effective plasma substitute.