The Clinical Study Of Acute Normovolemic Hemodilution(ANH) On Intraoperative And Postoperative Rehabilitation In Neurosurgical Patients Undergoing Excision Of Meningioma

Objective:The study was designed to evaluate the safety of acute normovolemic hemodilution(ANH) in combination with intraoperative cell-salvage and its efficacy in reducing the need for allogeneic blood transfusion and the effect on postoperative rehabilitation in neurosurgical patients undergoing excision of meningioma. where the blood loss is 1000 ml to 2000 ml.Methods:This was a prospective study that all patients undergoing excision of elective intracranial meningioma is from August 2013 to February 2015 in The First Affiliated Hospital Nanchang University. The patients were randomly allocated to two groups.In ANH group,patients were received acute normovolemic hemodilution(ANH) in combination with cell salvage. In control group, patients were only received intraoperative cell-salvage. Hemodyna- mic parameters,internal environment, were measured at the following time: 10 minutes after intratracheal intubation(T1), 10 minutes before operation(T2), before retransfusion(T3), suturing the dura(T4) in ANH group.And the same parameters were measured at the following time(corresponding to the ANH group):10 minutes after intratracheal intubation(T1),10 minutes before operation(T2), before retransfusion(T3), suturing the dura(T4) in control group. Intraoperative blood loss and duration of operation were evaluated in two groups at the end of operation. Also the number of patients requiring allogeneic blood and coagulation tests were evaluated at the end of operation. And postoperative infection, the incidence of reoperation, postoperative hospital stay and the Karnofsky Performance(KPS)Score at discharge were the outcome evaluated in two group.Results:All patients meet the inclusion criteria, exclusion criteria and elimination criteria.There were ultimately 30 patients in the ANH group and 30 patients in the control group. Patient demographics, preoperative hemoglobin levels and preoperative KPSscore were similar between the two groups(P>0.05). The hemodynamic parameters at various stages of study were well maintained in both the groups. The heart rate, mean arterial pressure and central venous pressure did not differ significantly at different stages between the two groups(P>0.05). Serum electrolytes(sodium,potassium,calcium) and PH,BE also did not differ significantly at different stages between the two groups(P>0.05). Mean hemoglobin and hematocrit levels after blood drainage(T2) in ANH group were lower than in control group, the variation between the groups was statistically significant(P<0.05). Although the Intraoperative blood loss was comparable between the ANH groups and the control groups(P>0.05), the number of patients requiring allogeneic blood transfusion were significantly lower in the ANH groups compared to the control group(P<0.05). Duration of operation was similar between the two groups(P>0.05). And the number of patients coagulopathy were significantly lower in the ANH groups compared to the control group(P<0.05).Postoperative infection, postoperative hospital stay, the incidence of reoperation, the KPS score at discharge were similar between the two groups(P>0.05).Conclusion:Our study has shown that ANH in combination with intraoperative cell-salvage is a safe and effective means of reduce the need for allogeneic blood and is good to recovery coagulation. It probably did not lead to promote postoperative rehabilitation in patients undergoing excision of elective intracranial meningioma.