Application Of Acute Normovolemic Hemodilution Combined With Controlled Hypotension On Patients Undergoing Spinal Operation

OBJECTIVE:To evaluate the clinical effect and security of acute normovolemic hemodilution (ANH) combined with controlled hypotension (CH) on patients undergoing spinal operation.METHODS:A total of110patients undergoing complicated spinal operation from October2012to September2013in our hospital were included in our program:55patients (observed group), operated from April2013to September2013, underwent ANH combined CH, and55patients (control group), operated from October2012to March2013, underwent pure CH. After tracheal intubation, patients in the observed group received ANH and the blood volume that was taken off was determined by the Gross formula. Both of the two groups were infused with nitroglycerin combined with esmolol for CH at the beginning of the surgery. The changes of MAP and HR in both groups were recorded at five different time points:before anesthesia induction (To), after tracheal intubation (T1),20min after CH(T2),30min before the end of operation(T3) and immediately after operation (T4). Blood samples were drawn from patients in both groups at To, T2, T4, the1st day after operation (T5) and the day before discharged (T6) to measure the Hb, Hct, and PLT. Coagulation function was performed at To and T5. Blood gas analysis and Glu were measured at T2, T4. Recorded the operating time, the infusion volume, the urine volume, the amount of bleeding, the volume and rate of intraoperative and postoperative allogenic blood transfusion, the postoperative drainage volume and adverse events of both groups.RRSULTS:②Compared with To, MAP in the two groups were significantly decreased at T1, T2, T3and HR were significantly decreased T1, T2(P<0.05). There were no significant differences between the two groups in the values of MAP and HR at the same time point (P>0.05).②Compared with control group, the infusion volume and urine volume of observed group were significantly increased, and the volume and rate of allogeneic blood transfusion were significantly decreased (P<0.05). The differences of the amount of bleeding during the operation, the volume and rate of allogeneic blood transfusion after the operation and postoperative drainage volume between the two groups were not significant (P>0.05).③Compared with To, Hb, Hct were significantly decreased in the two groups (P<0.05), but there were no significant differences between the two groups at all of the time points excepted that at T2(P>0.05).④Compared with To, PT in observed group was significantly increased and FIB was significantly decreased at T5(P<0.05).CONCLUSION:Compared with pure CH,moderate ANH combined with CH can significantly decrease the volume and rate of intraoperative allogenic blood transfusion, and it has no obvious impact on hemodynamic, fibrinolysis and coagulation function. The study suggests that ANH combined with CH is safe to use in spinal operation.