| Background:In recent years, the Population of elderly People is increasing rapidly in our country with the development of economy and the enhancement of living standard. So is the elderly patients who need surgery.Anesthesia for the elderly is now being payed more attention than ever before. The category and quantity and difficulty of geriatric patients will gradually gain in clinic and the quantity of xenogenous blood is largely used during the operation for the geriatric patients. The complications caused by xenogenous transfusion become more and more in recent years. Among these complications, Hepatitis and AIDS derived from the infection of virus have become a serious social problem. In new century, our country will face the more severe situation such as defict of blood source and more serious infection after transfusion. So how to save blood is a important medical studying topic. With the development of the study on the mechanism of hemodilution, Preoperative hemodilution has become one of the most frequently used and effective technique for blood saving. HD makes the cell component of the blood decrease comparatively or absolutely and reduces blood concentration to great extent so as to lower the number of cells flowing out. There by, It reduces loss of red blood cell. HD include three major methods:Acute Normovolemic Hemodilution (ANH) Acute Hypervolemic Hemodilution (AHH) and Actue Non-Isovolemic Hemodilution, (ANIH). AHH is a new way of saving blood that was put forth in the nineties of twentieth century, compared with ANH, AHH can save time and cost,and reduce contamination of blood, it will be more widely used in clinic gradually. But the systemic investigation on the using of AHH in geriatric patients, especially for the aging people, all of organ function in body will decrease, the influence of AHH on hemodynamics function and the degree of tolerance is still more elementary and clinical study.Preoperative Acute Hypervolemic Hemodilution, usually choose crystals or colloid. In Present, there is a lot of category of Plasma substitute(Hydroxyethyl stacrh, Gelofusine, Dextran, Haemaccel, ect)in clinic. Ringers lactated solution is pretty low permeability solution,2/3 above after the input into the extracellular fluid, can only maintain expansion 20%, expands the time is 20～30 min. Polyegline molecular peptide (MV) for 27500～39500 Dal, the half-life is 5 hours, input, after the expansion of 100% vascular and blood viscosity,it can improve the oxygen of the organs and tissues.High osmotic sodium chloride Hetastarch 40 injection was included 4.2% chloride/7.6% hydroxyethyl starch, theory 1400mOsm/L for mole fraction osmotic pressure, substitution degree of 0.8～1.3, clinical transfusion smaller doses can achieve expansion.Objective:To investigate the hemodynamic effects of acute hypovolemic hemodilution with different liquids in elderly surgical patients.Methods:Sixty ASAⅠ～Ⅱpatients with Hb≥110 and HCT 35～45%,60～70yr, weighed 45-65kg undergoing elective lower extremity operation, processed epidural combining spinal anesthesia were randomly divided into three groups,Ⅰ(high osmotic sodium chloride Hetastarch 40 5 ml/kg and Ringers lactated solution 10ml/kg),Ⅱ(Polyegline 5 ml/kg and Ringers lactated solution 10ml/kg) andⅢ(Ringers lactated solution 5 ml/kg and Ringers lactated solution 10ml/kg). Three different liquids were injected into the patients through vein before and after of the epidural combining spinal anesthesia in the three groups differently. MAP and HR of all the patients were measured and recorded at different times. Blood samples were taken from the other arm to determine Hb, Hct. And compared them with the level of that into the operating room. Observe any allergies, pulmonary edema and central nervous system disorders. The quantity of liquids injected into the patients and urine discharged by the patients, the quantity loss of blood, the dosage of ephedrine during the whole operation were recorded, and the total time of the whole operation.Results:There were no significant differences in the three groups with age, weight, the quantity of urine discharged and the total time of the whole operation. ALL the three groups achieved the mild degree of hemodilution. In groupⅠthere were significant differences in MAP when compared the level of the start of the narcotic injected into the patients (T1) with the level of into the operating room (T01).In groupⅡthere were significant differences in MAP when Compared the level of the start of the narcotic injected into the patients (T1), the level of 20 minutes after the narcotic injected into the patients (T3) and the level of 1 minute after the tourniquet was released (T5) with the level of into the operating room(T01). In groupⅢ, when compared with the level of into the operating room (T01), there were significant differences in MAP in the start of the narcotic injected into the patients (T1),20 minutes after the narcotic injected into the patients (T3),1 minute after the tourniquet was used (T4),1 minute after the tourniquet was released (T5) and 10 minute after the tourniquet was released (T6).1 patients inⅠgroup,6 inⅡgroup and 17 inⅢgroup were injected at least 10mg ephedrine.Conclusion:1.This study confirms that small doses of high osmotic sodium chloride Hetastarch 40 injection 40 (5ml/kg) composite Ringers lactated solution (10ml/kg) with AHH can achieve mild hemodilution effect.2. This study confirms it is safe that in general, no anemia, no heart and lung disease and other basic diseases.ASAⅠ～Ⅱof elderly patients, composite joint under epidural combining spinal anesthesia AHH with high osmotic sodium chloride Hetastarch 40 (5 ml/kg) and Ringers lactated solution (10ml/kg).3. This study confirms that small doses of high osmotic sodium chloride Hetastarch 40 injection 40 (5ml/kg) composite Ringers lactated solution (10ml/kg) with AHH can achieve superior effect than Polyegline and Ringers lactated solution.4. This study confirms that small doses of high osmotic sodium chloride Hetastarch 40 injection 40 (5ml/kg) composite Ringers lactated solution (10ml/kg) with AHH can alleviate the influence of anesthesia and release the tourniquet to the circulation of blood. it can be well tolerated by the elderly patients, it is beneficial for maintaining hemodynamic stability. It is worthy of popularizing. |
PDF Full Text Request