| In recent years,more and more problems caused by allogeneic blood transfusion and our country is facing the serious situation of blood shortages.Therefore,it is an important subject of the current medical research to save blood and reduce blood transfusion.The clinical application of an effective blood conservation method is acute hypervolemic hemodilution(AHH).With the aging of the population in our country,more and more old people need surgical operation.However,the safety and effectiveness of AHH in the elderly still needs to be further explored.The purpose of this study was to evaluate the effects of different fluids on blood coagulation in elderly patients and to provide reference for clinical treatment.Objective: To investigate the influences of AHH with different liquids on hemodynamics and coagulation function in the elderly patients with laparoscopic pancreaticoduodenectomy.Methods: 45 elderly ASA Ⅱ or Ⅲ patients scheduled for laparoscopic pancreaticoduodenectomy were randomly divided into three groups: control group(group R),AHH with 6% Hydroxyethyl Starch130/0.4(group H),AHH with 4% Gelofusine(group G),each group containing 15 cases.Radial artery was cannulated with 1% lidocaine for Invasive arterial pressure monitoring.All patients in three groups were input lactate Ringer’s solution 10ml/kg for preoperative fluid restriction.Then group H and group G were infused 6% Hydroxyethyl Starch130/0.4 and 4% Gelofusine which contained 1/3 of total pre metering(15ml/kg)at a rate of 25ml/min to prevent the hypotension cased by the induction of general anesthesia.Anesthesia was induced with midazolam 0.05mg·kg-1,Sufent-anil 0.3μg·kg-1,propofol 1.5mg·kg-1,cisatracurium 0.15mg·kg-1,atropine 0.5mg,remifentanil 1 ~ 2μg·kg-1 and maintained with propofol 4 ~ 6mg·kg-1·h-1 and remifentanil 0.1 ~0.3μg·kg-1·min-1.Muscle relaxation was maintained with cisatracurium.Right internal jugular vien catheterization was performed after mechanical ventilation for fluid resuscitation and CVP monitoring.The other 2/3 was infused before operation in order to achieve the super capacity of blood dilution.In group R,lactate Ringer’s solution was input conventionally at a rate of 15ml·kg-1·h-1.Blood transfusion was considered when Hb<80g/l,Hct<25%.Similarly diuretic was given when CVP>15cm H2 O.Venous blood samples were taken before AHH(T0),30 minute after AHH(T1),1 hour after AHH(T2),at the end of the operation(T3)for measuring TEG parameters(R,K,Angle,MA,LY30)and blood gas indexes(Hb,Hct).Sp O2,Pet CO2,HR,MAP,CVP,T,BIS were monitored continually during the whole operation.Urine,blood transfusion and blood loss were also recorded during the operation.Results:(1)There were no significant differences in gender composition,age,body weight,operation time,blood loss in the three groups.(P >0.05)(2)Blood transfusion and total liquid input in group R was significantly higher than that in group H and group G(P<0.05),however the urine volume of patients in group H and group G was significantly higher than that in group R(P<0.05).(3)There were no significant differences among groups on HR、MAP、CVP、Sp O2、Pet CO2 before AHH(P>0.05).Compared with T0,MAP in group R was decreased at T1,and there were statistically significant differences with group H and group G(P<0.05 or P<0.01)MAP at the rest time of the three groups were basically stable and there was no difference between the groups.(P>0.05)Compared with T0,HR in group H and group G was significantly decreased at T1(P<0.05),there was no difference between the two groups,but the difference was statistically significant between group G and group R(P<0.05).There was no difference in the three groups of Pet CO2 and Sp O2 at each time point.CVP in group R was lower at T1 compared with T0,CVP in group H and group G were significantly increased at T1、T2、T3,and the difference was statistically significant compared with the group R at T1(P<0.05).There was no difference in T and BIS between the three groups(P>0.05).(4)Compared with T0,Hb,Hct in group R had no difference among T1-T3,but in group H and group G were significantly reduce after AHH(P<0.05)and there was no significant difference between the two groups.(P>0.05)(5)the indexes of TEG: There were no significant differences in the TEG parameters between three groups before AHH(P>0.05);The ACT at T1,T2,T3 prolonged significantly than that at T0 within group H and group G comparison(P<0.05),besides there were significant difference between group H,group G and group R after AHH.(P<0.05);R value at T1,T2,T3 were higher than at T0 within group H and group G and the difference was statistically significant(P<0.05).There were differences of the R value between group H,group G and group R,besides the difference was statistically significant(P<0.05).K value and Angle: these parameters had statistically significantly at T3 compared with T0 within group H and group G except group R(P < 0.05).There were significant differences of these parameters between group H,group G and group R(P<0.05).MA were reduce at T3 compared with T0 within group H and group G(P<0.05),and there were statistically significant differences between three groups(P <0.05).There were no differences on LY30 and EPL(P>0.05).Conclusions:(1)6%Hydroxyethyl starch 130/0.4 and 4%Gelofusine could be used for capacity replacement therapy safely and effectively on elderly patients undergoing laparoscopic pancreaticoduodenectomy.(2)AHH could help to maintain the stability of hemodynamics,reduce the amount of blood loss and allogeneic blood transfusion.(3)4%Gelofusine and 6%Hydroxyethyl starch 130/0.4 could improve the high coagulation state of elderly patients effectively,and 6%Hydroxyethyl starch 130/0.4 could make the blood of patients with slight hypocoagulation state at the end of operation which had great significance on the prevention of postoperative venous thrombosis.(4)TEG can monitor coagulation function dynamically which provide important data for clinical perioperative coagulation function monitoring. |
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