Effects Of Acute Hypervolemic Hemodilution Combined With Controlled Hypotension On Expression Of Serum Procalcitonin, C-reactive Protein,Interleukin-6 In Patients With Spinal Surgery

Objective Because of the influence of operative field bigger, rich blood supply of vertebral body and long operation time and so on, quite a number of spinal surgeries in clinical bleeding is more, and need blood transfusion treatment. In recent years, as the two different mechanisms of blood conservation measures, acute hypervolemic hemodilution (AHH) combined with controlling hypertension (CH), can significantly reduce the intraoperative blood loss, decrease the rate of allogeneic blood transfusion, relieve the strain on blood source, is an effective and comprehensive blood conservation measures. Now a lot of studies have testified that immune system of the body was suppressed after having surgical trauma and anesthesia, which can be shown by the excessive inflammatory reaction and the following cell immunosuppression,the "excessive inflammation-immunosuppression" state cause of complications including postoperative infection, SIRS, sepsis and MODS and so on is often the important cause of death. PCT is a new kind of inflammatory markers in recent years, is not only response rapidly, but higher sensitivity and specificity compared with the traditional inflammation markers.There is few article about the influence of the PCT by AHH combined with CH. This study intends to observing the concentration of inflammatory markers in the patient by AHH combined with CH, roughiy estimate the degree of inflammation in spinal surgery patients, early predict the complications, provide reference for clinical.Methods Choose sixty patients of ASA Ⅰ or Ⅱ undergoing elective fitting line of lumbar spinal stenosis, lumbar disc, with screw rod fixation, were randomly divided into three groups (n=20):AHH group, AHH+CH group and control group. AHH group received AHH,6% HES 15ml/kg was infused at a rate of 30 ml/min after anesthesia induction. AHH+CH group received AHH and CH, CH was induced with nitroglycerin hypotension to keep MAP 60-70 mm Hg. The amount of intraoperative blood loss and blood transfusion of patients were recorded. The venous blood samples were taken at the beginning of AHH (T1),after AHH (T2),2 hours after the surgery (T3),the end of the surgery (T4) and the 1 day after surgery (T5) to measure the serum procalcitonin, C-reactive protein, interleukin-6.Results There were no statistically significant differences in three groups of patients with gender, age, weight, and the operation time. The intraoperative blood loss and blood transfusion amount in group AHH and AHH+CH is less than the control group obviously. Compared to Ti, the concentration of CRP and IL-6 in group AHH and AHH+CH at T2 was reduced, but there was no statistically significant difference; the CRP and IL-6 were increased at T3～T5 in three groups(P<0.05). CRP and IL-6 were lower in group AHH and AHH+CH than those in control group at T2-T5 (P<0.05), there was no statistically significant difference between AHH and AHH+CH group.At T3,the concentration of PCT in control group can be detected. At T4, the concentration of PCT in group AHH and AHH+CH can be detected. PCT in group AHH and AHH+CH at T4～T5 was lower than those in control group(P<0.05).Conclusion In spinal surgery, inflammatory markers PCT, CRP, IL-6 increased gradually. AHH or combined with CH can abate blood loss and blood transfusion during spinal surgery, inhibitting the expression of serum PCT, CRP, IL-6 during perioperative, reducing the systemic inflammatory response.