Objective To evaluate the security and validity of the acute extreme hypervolemic hemodilution (AEHH) in spine surgery. Methods Thirteen patients(8 males, 5 females; age, 16-65 years; weight, 50-75 kg) who had undergone major spine operations were enrolled in this study. Eleven of them had undergone anterior decompression, who were given the grafting and the internal fixation for their thoracolumber spinal burst fractures; the other 2 patients were given the correction operation for their scoliosis. The baselines of the haematocrit (Hct）were 0.363-0.481 before operation. The patients had no cardiac, pulmonary, hepatic or renal dysfunction or coagulation abnormality. The hemodynamic status and the haematocrit were observed during operation. The parameters of thromboelastography (TEG)，arterial blood gas, and electrolytes were measured and observed at the following time points: before AEHH, after AEHH, 60 minutes after AEHH, 120 minutes after AEHH, and the end of the operation. The total fluid volume was recorded. Results The autologous blood volume was1 050-1 575 ml (average,1 419±198 ml), plasma substitute 2 100-3 150 ml (average,2 838±397 ml), blood loss1 000-3 130 ml (average, 1 747±743 ml), urine 450-1 270 ml (average, 871±374 ml), and the net blood transfusion 1 206-2 661 ml(1 863±598 ml). The homogenous blood of 400 ml was transfused in 1 patient for making upthe blood loss of 3 130 ml. There were no statistically significant differencesin the hemodynamic measurements, arterial blood gas, and electrolyte variables when compared with the baseline values before the hemodilution (Pgt;0.05). The reaction time of TEG was longer 60 minutes after AEHH than before AEHH (Plt;0.05); the other parameters of TEG had no differences when compared with the baseline values (Pgt;0.05). Conclusion The AEHH is safe and efficient in reduction of the perioperative homogenous blood transfusion in spine surgery.
ObjectiveTo investigate the influence of 6% hydroxyethyl starch (HES, 130/0.4)on blood coagulation of patients after off-pump coronary artery bypass grafting (opCAB)by thromboelastography (TEG). MethodsOne hundred patients undergoing elective opCAB in Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command between May and July 2013 were enrolled in this study. All the patients were randomly divided into 2 groups using random number table method with 50 patients in each group. In the experimental group (G1 group), there were 27 males and 23 females with their age of 64.9±4.4 years, who received intravenous 6% HES (130/0.4)20 ml/kg in 4 hours postoperatively. In the control group (G2 group), there were 31 males and 19 females with their age of 63.1±5.8 years, who received intravenous lactated ringers 20 ml/kg in 4 hours postoperatively. After postoperative ICU admission, full blood count, coagulation tests and TEG were examined. Chest and mediastinal drainage was recorded at 6 hours and 24 hours postoperatively. ResultsThere was no statistical difference in chest and mediastinal drainage 24 hours postoperatively between the 2 groups (591.7±171.7 ml vs. 542.4±174.0 ml, P > 0.05). None of the patients received reexploration for bleeding. There was no statistical difference in hemoglobin, hematocrit, platelet count or traditional coagulation index between the 2 groups (P > 0.05). TEG showed no significant change in coagulation time after intravenous fluid infusion in either group. Reaction time was slightly extended in both groups, but there was no statistical difference in reaction time between the 2 groups (P > 0.05). Maximum amplitude (MA)of G1 group was significantly decreased after intravenous fluid infusion (55.9±10.0 mm vs. 62.8±7.9 mm, P < 0.05), but still within the normal range. There was no significant change in MA after intravenous fluid infusion in G2 group. ConclusionIntravenous infusion of 6% HES (130/0.4)20 ml/kg can reduce platelet function and clot strength, but does not significantly increase postoperative chest or mediastinal drainage, or the incidence of postoperative reexploration for bleeding. It's safe to administer 6% HES (130/0.4)for patients after OPCAB.