The Effects Of Fluid Management On Coagulation And Blood Loss In Spinal Deformity Surgery

ObjectiveIn this study, our primary purpose is to investigate the effects of different fluid management on coagulation and blood loss in patients undergoing spinal deformity surgery. The effect of application of intraoperative blood salvage on blood loss and transfusion during and after surgery were compared simultaneously, so as to provide a guidance of fluid therapy and blood conservation for this kind of surgery.MethodsSeventy-two patients with spinal stenosis scheduled for posterior lumbar spinal deformity surgery were enrolled to the studied. They were randomly divided into the following three groups:the LRS group, receiving LRS10ml. kg-1, h-1, the HES group, receiving LRS5ml. kg-1.h-1+HES5ml. kg-1.h-1) and the Gel group, receiving LRS5ml. kg-1. h-1+Gel5ml. kg-1.h-1). Twenty-four cases in each group. All patients received general anesthesia with tracheal intubations after central venous catheterization and radial arterial cannulation. Fluid therapy stared when anesthesia was completed. Blood conservation techniques with cell saver were used when the hemorrhage volume during surgery was larger than expected, especially in those with the fusion more than3levels. The washed red blood cells were transfused to the patients before the termination of operation. SBP, DBP, MAP, HR, SpO2, ET-CO2were recorded at the time points of before anesthesia (T1), immediately after induction (T2), before skin incision (T3),60min after skin incision (T4)120min after skin incision (T5),180min after skin incision (T6), at the end of surgery (T7). Arterial blood gas, D-dimmer, blood coagulation and hematology were tested at T3and T7. Liver and kidney function parameters, surgical time, the consumption of anesthetics, intraoperative infusion volume, blood transfusion, urine output and the blood loss were recorded. Postoperative recovery and complications were observed, such as the recovery of gastrointestinal function and the wound healing.Statistical analysis SPSS17.0statistical software was used to data analysis. The normal distribution test was conducted in the variables. If the measurement data are fitted with normal distribution they were expressed in X±s, otherwise, expressed in95%confidence interval. Analysis of variance was used to analyze quantitative data, and Chi-square test was used to analyze enumeration data. P<0.05was considered as statistically significant.Results1.The difference of general condition between the three group patients were not statistically significant (P>0.05);2. The difference of arterial blood gas analysis results between the three groups when compared preoperative and postoperative were also not statistical significant (P>0.05);3. The PT, INR and APTT of the three groups were significantly extend or increase, when compared with the pre-anesthetic values, while the FIB and AT reduced significantly (P<0.001);4. The prolongation of PT and APTT in the two colloid group at the end of surgery were significantly greater than the LRS group (P<0.05). The differences of the changes of AT, FIB and INR were also significant in the two colloid group than the LRS (P<0.05-0.001). There were no significant difference when compared these parameters between the HES and LRS group(P>0.05)5. The difference of blood loss and urine output between the three groups were not significant (P>0.05);6. D-dimer were higher than preoperative all the three groups(P<0.01) but there were no significant differences between the groups (P>0.05).7. Mean surgical time, the spinal fusion level and blood loss during surgery were longer or greater in the cell saver group than non-saver group (P<0.001).There were no difference between the cell saver group and non-saver group in the total amount of crystalloid fluid and colloid solution, and the rate of blood transfusion, the units of transfusion and the blood parameters such as Hb, Hct, PLT, PT and FIB were all no difference between the two groups (P>0.05)Conclusion1. Intraoperative fluid therapy, whether simply using LRS or combined with HES or Gel, coagulation function were weakened as compared the preanesthesia values. The coagulation function were worse in group HES or Gel than in group LRS.2. The decrease of coagulation function at the end of surgery were mainly due to consumption of coagulation factor for wound hemostat and hemodilution by the fluid therapy.3. The slight differences of coagulation function among the three groups had no significant affect on blood loss during surgery.4. The increased D-dimer suggested a secondary fibrinolysis were increased during surgery, so antifibrinolytic drugs may be indicated.5. Blood salvage may help to maintain a stable circulation and reduce blood transfusion during spine surgery when intraoperative blood loss is higher, but it seems no substantial effect on the reduction of postoperative blood transfusion.