Abstract：Objective To evaluate impacts of acute hypervolemic hemodilution (AHH) and intraoperative cell salvage (ICS) with 6% volume fraction of hydroxyethyl starch (HES) on hemodynamics, blood saving efficiency and renal function of orthopedic surgery patients. Methods A total of 58 patients from orthopedic surgery were involved and randomly divided into AHH+ICS group (30 cases) and control group (28 cases). Changes of hemodynamic indices (HR, MAP and CVP) and renal function indices (BUN, BCr, UCr and ALB) in both groups were compared before operation (T0), immediately after operation (T1) and at postoperative 4 hours (T2), 1 day (T3) and 2 days (T4). CCr was counted and intraoperative blood conservation was observed at each time point as well. Results HR, MAP and CVP of the two groups had no significant differences. Both groups showed some drop of HR (P＜0.05), but an increase of MAP and CVP at T1-T4 (P＜0.05), in contrast with levels at T0. BUN, BCr and ALB also showed insignificant differences between groups or within group at each time point. CCr in the control group showed no significant difference at each time point. On the contrary, CCr in the AHH+ICS group had a fall at T1-T4 and was declined to the lowest level at T2. CCr in the AHH+ICS group showed a recovery at T3-T4 and its level at T4 was still lower than that at T0, with no significant difference. CCr in the two groups showed insignificant difference at T0, but its level in the AHH+ICS group was lower than that in the control group at T1-T4, at T2 in particular (P＜0.01). Moreover, CCr in the two groups was still significantly different at T4 (P＜0.05). Renal function indices of the two groups were all within normal range at each time point. Intraoperative blood loss and unrine volume of the two groups had no significant differences, but intraoperative fluid requirement, allogenic blood transfusion volume and transfusion rate of AHH+ICS group were notably lower than those of control group (P＜0.05 or P＜0.01). Conclusions AHH plus ICS using HES are safe, effective and promising integrated blood conservation measures, which significantly reduces intraoperative allogenic blood transfusion volume and transfusion rate and has few impacts on fundamental vital signs and renal function. However, prolonged use of large dose of HES may do harm to renal function and therefore should be carefully considered in treatment of patients with severe renal dysfunction.
OU Shan,ZHOU Le-shun,BAI Shu-rong et al. Effects of acute hypervolemic hemodilution and intra-operative cell salvage on orthopedic surgery patients[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(3): 273-277.
［22］Jrres A, Kordonouri O, Schiessler A, et al. Urinary excretion of thromboxane and markers for renal injury in patients undergoing cardiopulmonary bypass. Artif Organs, 1994, 18(8):565-569.
［1］Dalton PD, Mey J. Neural interactions with materials. Front Biosci, 2009, 14:769-795.
［23］Boldt J, Brenner T, Lehmann A, et al. Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: comparison of a new starch preparation with gelatin. Intensive Care Med, 2003, 29(5):763-769.
