| Objective: To observe the effects of acute normovolemic hemodilution autologous blood transfusion on the depth of anesthesia,muscle relaxation effect and blood concentration of elderly patients undergoing orthopedic surgery,To evaluate the effects of autologous blood transfusion containing anesthetic ingredients on the quality and safety of postoperative anesthesia.Influence and explore the correlation between them.Methods: forty cases of elective orthopedic surgery were selected.The ASA classification was? to ?.bleeding volume estimated greater than 600 ml,the aged from 65 to 75 years,and the weight from 55 to 80 kg.No anemia and blood system diseases,normal blood routine,liver and kidney function,and hypoalbuminemia were preoperatively.Immune,myasthenia gravis,and mental disorders excluded.The cases were randomly divided into 2 groups with 20 in each group: A is an acute normovolemic hemodilution group.After the induction of anesthesia is stable,the target Hct from 28% to 30%.Blood is collected through the left radial artery and equal Volume of 6% medium molecular weight hydroxyethyl starch 130 / 0.4 injected the right internal jugular vein.Bleeding volume = EBV × 2 ×(Hct basis-Hct target)/(Hct basis + Hct target),EBV is the estimated blood volume in the body,with the weight(kg)× 70 ml / kg for male,and body weight(kg)× 60 ml / kg for female.Group B is the control group.The routine infusion was performed without blood dilution,that is,the crystal and colloid fluids wereroutinely input during the operation.If the amount of blood loss during surgery is large,allogeneic blood is given to supplement blood volume and blood loss.Before the induction of anesthesia(T0),before the start of ANH(T1),after the ANH(T2),autotransfusion of autologous blood(T3),autotransfusion of 10min(T4),autotransfusion of 20min(T5),autotransfusion The following indicators were observed at 30 min(T6),40 min(T7),50 min(T8),60 min(T9),Observe and record the EEG double frequency index(BIS)and four series of stimulation(TOF)at two time points from T3 to T9.Liquid chromatography-tandem mass spectrometry(LC-MS / MS)method was used to detect the plasma drug concentrations of propofol and cis-atracurium in two groups of patients at time points T3 to T9;At T1,T2,T3,T6,and T9,the mean arterial pressure(MAP),heart rate(HR),stroke volume variability(SVV),and continuous cardiac output(CCO)of the two groups were observed and recorded respectively.Variety;blood gas and electrolytes were measured at T0 and T9 time points of two groups of patients,and parameters of PaO2,PaCO2,pH,and lactic acid values were recorded;at the same time,the time from the T3 time point of the two groups to the tracheal catheter removal;According to the Aldrete score scale,the patients' awake status at T9 was evaluated.Results:(1)The BIS value of group A was significantly lower than that of group B at time points T8 and T9(p <0.05).There was no statistical difference between group A and group B at time points T3 to T7(p> 0.05);group A The TOF value was significantly lower at the T9 time point than in the control group(p <0.05).There was no statistical difference between groups A and B at T4 to T8 time points(p> 0.05);(2)T3 time point in group A The blood concentration of propofol was significantly lower than that of the control group(p <0.05),and there was no statistical difference between the groups at time points T4 to T9(p> 0.05).There was no statistical difference in blood concentration between groups(p> 0.05);(3)Comparison of intraoperative fluid infusion between the two groups,the infusion in group A was significantly higher than that in group B(p <0.05);(4)T2 At time point,the MAP value in group A was significantly lower than that in group B(p <0.05);the stroke variability(SVV)was significantly higher in group A than in group B at time T2,T3,T6,and T9(p <0.05);There were no statistical differences in the hydrodynamic indexes between the time points(p>0.05);(5)PaCO2 and Lac in the two groups were significantly higher than the T0 time point in the T9 time point(p <0.05);The pH value of the patients in the group was significantly lower at the T9 time point.T0 time point(p <0.05);the Lac value of group A at T9 time point is significantly higher than that of group B(p <0.05);the Po2 value of group A at T9 time point is lower than that of group B(p> 0.05).Learn the difference.(6)The tracheal catheter removal time was significantly longer in group A than in group B(p <0.05);the Aldrete score of group A was significantly lower than that of group B(p <0.05).Conclusion: Moderate degree of acute normovolemic hemodilution is used in elderly orthopedic surgery.After autologous blood transfusion,the concentration of propofol and cis-atracurium in the patient's plasma is not significantly changed,However,it can enhance the depth of anesthesia and muscle relaxation effect of postoperative patients,and delay the recovery of respiratory function and extubation time in elderly patients. |
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