Objective To observe the effects of acute normovolemic hemodilution （ANH） on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. Methods Thirty elderly patients （aged 60-70 y...Objective To observe the effects of acute normovolemic hemodilution （ANH） on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. Methods Thirty elderly patients （aged 60-70 years） with liver cancer （American Society of Anesthesiologists physical status I-II） scheduled for hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group （n= 15） and control group （n= 15）. After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch （HES） （130/0.4）, and basic liquid containing 6% HES and routine Ringer＇s solution, respectively. In all the studied patients, blood samples were drawn at five different time points： before anesthesia induction （T1）, 30 minutes after ANH （T2）, 1 hour after start of operation （T3）, immediately after operation （T4）, and 24 hours after operation （Ts）. Then co- agulation function, soluble fibrin monomer complex （SFMC）, prothrombin fragment （F1＋2）, and platelet membrane glycoprotein （activated GPIIb/GPIIIa and P-selectin） were measured. Results The perioperative blood loss was not significantly different between the two groups （P〉 0.05）. The volume of allogeneic blood transfusion in ANH group was significantly smaller than that in control group （350.5±70.7 mL vs. 457.8±181.3 mL, P〈0.01）. Compared with the data ofT1, prothrombin time （PT） and activated partial thromboplastin time in both groups prolonged significantly after T3 （P〈0.05）, but still within normal range. There were no significant changes in thrombin time and D-dimer between the two groups and between different time points in each group （all P〉0.05）. SFMC and F1 ＋2 increased in both groups, but without statistical significance. P-selectin expression on the platelet surface of ANH group was significantly lowered atT2 andT3 compared with the level atT1 （P〈 0.05）. Compared with control group, P-selectin was sig-nificantly lower in ANH group atT2-T3 （all P〈0.05）. Conclusions In elderly patients undergoing resection of liver cancer, ANH may not hamper fibri- nolvsis and coagulation function. It coukt therefore be safe to largely reduce allogeneic blood transfusion.展开更多
Background:Plasma expanders are widely used for acute normovolemic hemodilution(ANH).However,existing studies have not focused on large-volume infusion with colloidal plasma expanders,and there is a lack of studies th...Background:Plasma expanders are widely used for acute normovolemic hemodilution(ANH).However,existing studies have not focused on large-volume infusion with colloidal plasma expanders,and there is a lack of studies that compare the effects of different plasma expanders.Methods:The viscosity,hydrodynamic radius(Rh)and colloid osmotic pressure(COP)of plasma expanders were determined by a cone-plate viscometer,Zetasizer and cut-off membrane,respectively.Sixty male rats were randomized into five groups with Gelofusine(Gel),Hydroxyethyl Starch 200/0.5(HES200),Hydroxyethyl Starch 130/0.4(HES130),Hydroxyethyl Starch 40(HES40),and Dextran 40(Dex40),with 12 rats used in each group to build the ANH model.ANH was performed by the withdrawal of blood and simultaneous infusion of plasma expanders.Acid-base,lactate,blood gas and physiological parameters were detected.Results:Gel had a lower intrinsic viscosity than HES200 and HES130(P<0.01),but at a low shear rate in a mixture of colloids,red cells and plasma,Gel had a higher viscosity(P<0.05 or P<0.01,respectively).For hydroxyethyl starch plasma expanders,the COP at a certain concentration decreases from 11.1 mmHg to 6.1 mmHg with the increase of Rh from 10.7 nm to 20.2 nm.A severe ANH model,with the hematocrit of 40%of the baseline level,was established and accompanied by disturbances in acid-base,lactate and blood gas parameters.At the end of ANH and 60 min afterward,the Dex40 group showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other groups.The systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)decreased significantly in all groups at the end of ANH.The DBP and MAP in the Dex40 group further decreased 60 min after the end of ANH.During the process of ANH,the Dex40 group showed a drop and recovery in SBP,DBP and MAP.The DBP and MAP in the HES200 group were significantly higher than those in the other groups at some time points(P<0.05 or P<0.01).Conclusions:Gel had a low intrinsic viscosity but may increase the whole blood viscosity at low shear rates.Rh and COP showed a strong correlation among hydroxyethyl starch plasma expanders.Dex40 showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other plasma expanders.During the process of ANH,Dex40 displayed a V-shaped recovery pattern for blood pressure,and HES200 had the advantage in sustaining the DBP and MAP at some time points.展开更多
BACKGROUND： Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE： To ...BACKGROUND： Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE： To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method. DESIGN： 1：1 paired grouping according to gender and controlled observation SETTING： Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University. PARTICIPANTS： Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items. According to 1：1 paired principle in gender, 90 enrolled patients were assigned into treated group （n=45） and control group （n=45）. There were 39 male and 6 female in the treatment group, and they were aged （76±6）years, ranging from 71 to 84 years, and hospitalized at the 14^th to 76^th hours after onset. There were 39 male and 6 female in the control group, and they were aged （76±6）years , ranging from 70 to 82 years, and hospitalized at the 16^th to 72^th hours after onset. METHODS： Therapeutic method： Patients of treated group received modified hemodilution combined therapy. 200 mL whole blood of patients was exchanged with 500 mL dextran-40 （including 20 mL danshen parenteral solution and 32 mg heparin） at the beginning of therapy; From the 2^nd day, compound huangqi tea bag （Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid） was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6^th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton（Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ） and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index： Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference （1995） was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5^th, 7^th and 14^th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time. MAIN OUTCOME MEASURES ： ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug. RESULTS： Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate： prothrombin time （PT）, activated partial thromboplastin time （APTT） and thrombin time （TT） of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group： （18.4±1.9）, （41.8±2.1）, （19.7±1.7） s, Before therapy in treated group： （13.4±1.3）, （35.8±1.3）, （12.5±0.9） s, After therapy in control group： （16.9±1.5）, （39.1±1.1）, （11.9±2.1） s, P〈 0.05]：Concentration of fibrinogen （Fbg） after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group： （3.4±0.4） g/L; Before therapy in treated group： （4.3±0.7） g/L; After therapy in control group：（4.0±0.6） g/L; P 〈 0.05]. Platelet aggregation rate decreased from （37.92 ±0.85）% before therapy to （26.42±1.01）% after therapy （P 〈 0.01）. ②Change of blood lipid level： Levels of total cholesterol （TC）, triacylglycerol（TG） and low density lipoprotein cholesterol （LDL-C） of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group： （5.2±0.9）, （1.9±0.9）, （2.08±1.1） mmol/L, before therapy in treated group： （5.9±1.2）, （2.8±0.9）, （3.94±0.5） mmol/L, After therapy in control group： （6.0±1.1）, （2.6±0.8）, （3.84±0.9） mmol/L, P 〈 0.05]. ③Change of hemorheology index： Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy： （43.84±4.55）% ;After therapy： （40.48±4.02）%;P 〈 0.05]. Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [（90±1.2）, （97±2.1） cm/s,P〈 0.01]. ⑤NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group （93%,78%, P 〈 0.05）. ⑥There was no obvious adverse effect. CONCLUSION： Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit, increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.展开更多
Objective The aim of this study was to evaluate the safety and efficacy of acute normovolemic hemodilution(ANH) during liver surgery.Methods Structured searches of the Pub Med,Chinese Biological Medicine Database,and ...Objective The aim of this study was to evaluate the safety and efficacy of acute normovolemic hemodilution(ANH) during liver surgery.Methods Structured searches of the Pub Med,Chinese Biological Medicine Database,and Cochrane Library electronic databases were performed,followed by a meta-analysis of outcomes,including intraoperative blood transfusion(s),intraoperative bleeding,postoperative hematocrit(Hct) levels,postoperative prothrombin time(PT),and number of patients who underwent transfusions during liver surgery.Results In total,14 eligible studies were included in the meta-analysis,which revealed that ANH for liver resection was associated with a reduction in intraoperative blood transfusions [weighted mean difference(WMD)-1.99;95% confidence interval(CI)-2.82 to -1.16;P<0.00001].The ANH group experienced less intraoperative bleeding(WMD -72.81;95% CI -136.12 to -9.50;P<0.00001) and exhibited a lower postoperative Hct level(WMD -3.38;95% CI -7.14 to -0.67;P<0.00001) than the control group.Moreover,meta-analysis revealed that postoperative prothrombin time was not affected by ANH(WMD -0.02;95% CI -0.18 to -0.32;P=0.65).Finally,the number of patients requiring allogeneic transfusion was significantly smaller in the ANH group than in the control group(odds ratio 0.13;95% CI 0.09 to 0.18;P=0.24).Conclusion Results of the present meta-analysis indicated that ANH can reduce intraoperative bleeding and the need for blood transfusions.In addition,ANH did not negatively affect the coagulation system after surgery;therefore,ANH appears to be safe and effective during liver surgery.展开更多
Using transesophageal echo-Doppler, it is demonstrated that preoperative acute hypervolemic hemodilution(HHD) with 6% hydroxyethel starch(HES) significantly increased in intravascular volume, DO2, CO, SV and CI, marke...Using transesophageal echo-Doppler, it is demonstrated that preoperative acute hypervolemic hemodilution(HHD) with 6% hydroxyethel starch(HES) significantly increased in intravascular volume, DO2, CO, SV and CI, markedly decreased in SVR and remained stable in MAP and HR, which indicates HES infused at 20 ml*kg-1 is safe in patient without cardiac disease.展开更多
Background Acute normovolemic hemodilution(ANH)was first introduced in glioblastoma surgery,and its role in reducing allogeneic blood transfusion was investigated in this study.Methods This study enrolled supratentori...Background Acute normovolemic hemodilution(ANH)was first introduced in glioblastoma surgery,and its role in reducing allogeneic blood transfusion was investigated in this study.Methods This study enrolled supratentorial glioblastoma patients who received total resection.In the ANH group,the patients were required to draw blood before the operation,and the blood will be transfused back to the patient during the operation.The association between ANH and clinical features was investigated.Results Sixty supratentorial glioblastoma patients were enrolled in this study,25 patients were allocated in the ANH group,and another 35 patients were included in the control group.ANH dramatically reduced the need for allogeneic blood transfusion(3[12%]vs 12[34.3%],P=0.049),and the blood transfusion per total of patients was dramatically decreased by the application of ANH(0.40±1.15 units vs 1.06±1.59 units,P=0.069).Furthermore,ANH also markedly reduced the requirement of fresh frozen plasma(FFP)transfusion(2[8%]vs 11[31.4%],P=0.030)and the volume of FFP transfusion per total of patients(32.00±114.46 mL vs 115.71±181.00 mL,P=0.033).The complication rate was similar between the two groups.Conclusions ANH was a safe and effective blood conservation technique in glioblastoma surgery.展开更多
The effects of phentolamine on hemorrheology and hemodynamics were studied in dogs with acute liver damage induced by acetaminophen. After 1 h of phentolamine application , the viscosity of plasma and whole blood was ...The effects of phentolamine on hemorrheology and hemodynamics were studied in dogs with acute liver damage induced by acetaminophen. After 1 h of phentolamine application , the viscosity of plasma and whole blood was significantly diminished. The hematocrit readings followed the same pattern as the alterations in viscosity. The portal venous resistance and the value of K were remarkably decreased and the portal venous blood flow was obviously increased. It can be assumed , therefore , that the decrease in viscosity induced by phentolamine results from internal hemodilution and phentolamine may improve hepatic blood circulation through the decrease of portal venous resistance caused by the reduction of blood viscosity and the dilation of portal vascular beds.展开更多
Background Hemoconcentration may be an important factor that determines the progression of severe acute pancreatitis （SAP）. In addition, it has been proposed that biomarkers may be useful in predicting subsequent ne...Background Hemoconcentration may be an important factor that determines the progression of severe acute pancreatitis （SAP）. In addition, it has been proposed that biomarkers may be useful in predicting subsequent necrosis in SAP. However, it is still uncertain whether hemodilution in a short term can improve outcome. We aimed to investigate the effect of rapid hemodilution on the outcome of patients with SAP. Methods One hundred and fifteen patients were admitted prospectively according to the criteria within 24 hours of SAP onset. Patients were randomly assigned to either rapid hemodilution （hematocrit （HCT） 〈35%, n=56） or slow hemodilution （HCT 〉35%, n=-59） within 48 hours of onset. Balthazar CT scores were calculated on admission, day 7, and day 14, after onset of the disease. Time interval for sepsis presented, incidence of sepsis within 28 days and in-hospital survival rate were determined. Results The amount of fluid used in rapid hemodilution was significantly more than that used in slow hemodilution （P 〈0.05） on the admission day, the first day, and the second day. There were significant differences between the rapid and slow hemodilution group in terms of hematocrit, oxygenation index, pH values, APACHE II scores and organ dysfunction at different time during the first week. There were significant differences in the time interval to sepsis in rapid hemodilution （（7.4±1.9） days） compared with the slow hemodilution group （（10.2±2.3） days）, and the incidence of sepsis （78.6%） was higher in the rapid group compared to the slow （57.6%） in the first 28 days. The survival rate of the slow hemodilution group （84.7%） was better than the rapid hemodilution （66.1%. P 〈0.05）. Conclusions Rapid hemodilution can increase the incidence of sepsis within 28 days and in-hospital mortality. Hematocrit should be maintained between 30%-40% in the acute response stage.展开更多
基金Supported by Ningbo Medical Technology Foundation (200612)
文摘Objective To observe the effects of acute normovolemic hemodilution （ANH） on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. Methods Thirty elderly patients （aged 60-70 years） with liver cancer （American Society of Anesthesiologists physical status I-II） scheduled for hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group （n= 15） and control group （n= 15）. After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch （HES） （130/0.4）, and basic liquid containing 6% HES and routine Ringer＇s solution, respectively. In all the studied patients, blood samples were drawn at five different time points： before anesthesia induction （T1）, 30 minutes after ANH （T2）, 1 hour after start of operation （T3）, immediately after operation （T4）, and 24 hours after operation （Ts）. Then co- agulation function, soluble fibrin monomer complex （SFMC）, prothrombin fragment （F1＋2）, and platelet membrane glycoprotein （activated GPIIb/GPIIIa and P-selectin） were measured. Results The perioperative blood loss was not significantly different between the two groups （P〉 0.05）. The volume of allogeneic blood transfusion in ANH group was significantly smaller than that in control group （350.5±70.7 mL vs. 457.8±181.3 mL, P〈0.01）. Compared with the data ofT1, prothrombin time （PT） and activated partial thromboplastin time in both groups prolonged significantly after T3 （P〈0.05）, but still within normal range. There were no significant changes in thrombin time and D-dimer between the two groups and between different time points in each group （all P〉0.05）. SFMC and F1 ＋2 increased in both groups, but without statistical significance. P-selectin expression on the platelet surface of ANH group was significantly lowered atT2 andT3 compared with the level atT1 （P〈 0.05）. Compared with control group, P-selectin was sig-nificantly lower in ANH group atT2-T3 （all P〈0.05）. Conclusions In elderly patients undergoing resection of liver cancer, ANH may not hamper fibri- nolvsis and coagulation function. It coukt therefore be safe to largely reduce allogeneic blood transfusion.
基金supported by the National Key Research and Development Program of China(2018YFC1106503)。
文摘Background:Plasma expanders are widely used for acute normovolemic hemodilution(ANH).However,existing studies have not focused on large-volume infusion with colloidal plasma expanders,and there is a lack of studies that compare the effects of different plasma expanders.Methods:The viscosity,hydrodynamic radius(Rh)and colloid osmotic pressure(COP)of plasma expanders were determined by a cone-plate viscometer,Zetasizer and cut-off membrane,respectively.Sixty male rats were randomized into five groups with Gelofusine(Gel),Hydroxyethyl Starch 200/0.5(HES200),Hydroxyethyl Starch 130/0.4(HES130),Hydroxyethyl Starch 40(HES40),and Dextran 40(Dex40),with 12 rats used in each group to build the ANH model.ANH was performed by the withdrawal of blood and simultaneous infusion of plasma expanders.Acid-base,lactate,blood gas and physiological parameters were detected.Results:Gel had a lower intrinsic viscosity than HES200 and HES130(P<0.01),but at a low shear rate in a mixture of colloids,red cells and plasma,Gel had a higher viscosity(P<0.05 or P<0.01,respectively).For hydroxyethyl starch plasma expanders,the COP at a certain concentration decreases from 11.1 mmHg to 6.1 mmHg with the increase of Rh from 10.7 nm to 20.2 nm.A severe ANH model,with the hematocrit of 40%of the baseline level,was established and accompanied by disturbances in acid-base,lactate and blood gas parameters.At the end of ANH and 60 min afterward,the Dex40 group showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other groups.The systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)decreased significantly in all groups at the end of ANH.The DBP and MAP in the Dex40 group further decreased 60 min after the end of ANH.During the process of ANH,the Dex40 group showed a drop and recovery in SBP,DBP and MAP.The DBP and MAP in the HES200 group were significantly higher than those in the other groups at some time points(P<0.05 or P<0.01).Conclusions:Gel had a low intrinsic viscosity but may increase the whole blood viscosity at low shear rates.Rh and COP showed a strong correlation among hydroxyethyl starch plasma expanders.Dex40 showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other plasma expanders.During the process of ANH,Dex40 displayed a V-shaped recovery pattern for blood pressure,and HES200 had the advantage in sustaining the DBP and MAP at some time points.
基金the Grant from Science and Technology Development Foundation of Railway Bureau of Shanghai, No. 3402052304/A
文摘BACKGROUND： Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE： To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method. DESIGN： 1：1 paired grouping according to gender and controlled observation SETTING： Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University. PARTICIPANTS： Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items. According to 1：1 paired principle in gender, 90 enrolled patients were assigned into treated group （n=45） and control group （n=45）. There were 39 male and 6 female in the treatment group, and they were aged （76±6）years, ranging from 71 to 84 years, and hospitalized at the 14^th to 76^th hours after onset. There were 39 male and 6 female in the control group, and they were aged （76±6）years , ranging from 70 to 82 years, and hospitalized at the 16^th to 72^th hours after onset. METHODS： Therapeutic method： Patients of treated group received modified hemodilution combined therapy. 200 mL whole blood of patients was exchanged with 500 mL dextran-40 （including 20 mL danshen parenteral solution and 32 mg heparin） at the beginning of therapy; From the 2^nd day, compound huangqi tea bag （Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid） was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6^th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton（Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ） and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index： Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference （1995） was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5^th, 7^th and 14^th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time. MAIN OUTCOME MEASURES ： ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug. RESULTS： Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate： prothrombin time （PT）, activated partial thromboplastin time （APTT） and thrombin time （TT） of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group： （18.4±1.9）, （41.8±2.1）, （19.7±1.7） s, Before therapy in treated group： （13.4±1.3）, （35.8±1.3）, （12.5±0.9） s, After therapy in control group： （16.9±1.5）, （39.1±1.1）, （11.9±2.1） s, P〈 0.05]：Concentration of fibrinogen （Fbg） after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group： （3.4±0.4） g/L; Before therapy in treated group： （4.3±0.7） g/L; After therapy in control group：（4.0±0.6） g/L; P 〈 0.05]. Platelet aggregation rate decreased from （37.92 ±0.85）% before therapy to （26.42±1.01）% after therapy （P 〈 0.01）. ②Change of blood lipid level： Levels of total cholesterol （TC）, triacylglycerol（TG） and low density lipoprotein cholesterol （LDL-C） of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group： （5.2±0.9）, （1.9±0.9）, （2.08±1.1） mmol/L, before therapy in treated group： （5.9±1.2）, （2.8±0.9）, （3.94±0.5） mmol/L, After therapy in control group： （6.0±1.1）, （2.6±0.8）, （3.84±0.9） mmol/L, P 〈 0.05]. ③Change of hemorheology index： Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy： （43.84±4.55）% ;After therapy： （40.48±4.02）%;P 〈 0.05]. Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [（90±1.2）, （97±2.1） cm/s,P〈 0.01]. ⑤NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group （93%,78%, P 〈 0.05）. ⑥There was no obvious adverse effect. CONCLUSION： Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit, increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.
文摘Objective The aim of this study was to evaluate the safety and efficacy of acute normovolemic hemodilution(ANH) during liver surgery.Methods Structured searches of the Pub Med,Chinese Biological Medicine Database,and Cochrane Library electronic databases were performed,followed by a meta-analysis of outcomes,including intraoperative blood transfusion(s),intraoperative bleeding,postoperative hematocrit(Hct) levels,postoperative prothrombin time(PT),and number of patients who underwent transfusions during liver surgery.Results In total,14 eligible studies were included in the meta-analysis,which revealed that ANH for liver resection was associated with a reduction in intraoperative blood transfusions [weighted mean difference(WMD)-1.99;95% confidence interval(CI)-2.82 to -1.16;P<0.00001].The ANH group experienced less intraoperative bleeding(WMD -72.81;95% CI -136.12 to -9.50;P<0.00001) and exhibited a lower postoperative Hct level(WMD -3.38;95% CI -7.14 to -0.67;P<0.00001) than the control group.Moreover,meta-analysis revealed that postoperative prothrombin time was not affected by ANH(WMD -0.02;95% CI -0.18 to -0.32;P=0.65).Finally,the number of patients requiring allogeneic transfusion was significantly smaller in the ANH group than in the control group(odds ratio 0.13;95% CI 0.09 to 0.18;P=0.24).Conclusion Results of the present meta-analysis indicated that ANH can reduce intraoperative bleeding and the need for blood transfusions.In addition,ANH did not negatively affect the coagulation system after surgery;therefore,ANH appears to be safe and effective during liver surgery.
文摘Using transesophageal echo-Doppler, it is demonstrated that preoperative acute hypervolemic hemodilution(HHD) with 6% hydroxyethel starch(HES) significantly increased in intravascular volume, DO2, CO, SV and CI, markedly decreased in SVR and remained stable in MAP and HR, which indicates HES infused at 20 ml*kg-1 is safe in patient without cardiac disease.
基金Fujian Provincial Health Technology Project(No.2021GGA031 to Qing-Song Lin)Natural Science Foundation of Fujian Province(No.2021J05148 to Qing-Song Lin)+2 种基金Fujian Provincial Finance Project(No.BPB-LQS2021 to Qing-Song Lin)Nature Science Foundation of Fujian province(No.2022J01678 to Ping Chen)Project to improve the diagnosis and treatment of intractable diseases of the cerebrovascular and nervous system(No.PT-YNBZW2018)
文摘Background Acute normovolemic hemodilution(ANH)was first introduced in glioblastoma surgery,and its role in reducing allogeneic blood transfusion was investigated in this study.Methods This study enrolled supratentorial glioblastoma patients who received total resection.In the ANH group,the patients were required to draw blood before the operation,and the blood will be transfused back to the patient during the operation.The association between ANH and clinical features was investigated.Results Sixty supratentorial glioblastoma patients were enrolled in this study,25 patients were allocated in the ANH group,and another 35 patients were included in the control group.ANH dramatically reduced the need for allogeneic blood transfusion(3[12%]vs 12[34.3%],P=0.049),and the blood transfusion per total of patients was dramatically decreased by the application of ANH(0.40±1.15 units vs 1.06±1.59 units,P=0.069).Furthermore,ANH also markedly reduced the requirement of fresh frozen plasma(FFP)transfusion(2[8%]vs 11[31.4%],P=0.030)and the volume of FFP transfusion per total of patients(32.00±114.46 mL vs 115.71±181.00 mL,P=0.033).The complication rate was similar between the two groups.Conclusions ANH was a safe and effective blood conservation technique in glioblastoma surgery.
文摘The effects of phentolamine on hemorrheology and hemodynamics were studied in dogs with acute liver damage induced by acetaminophen. After 1 h of phentolamine application , the viscosity of plasma and whole blood was significantly diminished. The hematocrit readings followed the same pattern as the alterations in viscosity. The portal venous resistance and the value of K were remarkably decreased and the portal venous blood flow was obviously increased. It can be assumed , therefore , that the decrease in viscosity induced by phentolamine results from internal hemodilution and phentolamine may improve hepatic blood circulation through the decrease of portal venous resistance caused by the reduction of blood viscosity and the dilation of portal vascular beds.
文摘Background Hemoconcentration may be an important factor that determines the progression of severe acute pancreatitis （SAP）. In addition, it has been proposed that biomarkers may be useful in predicting subsequent necrosis in SAP. However, it is still uncertain whether hemodilution in a short term can improve outcome. We aimed to investigate the effect of rapid hemodilution on the outcome of patients with SAP. Methods One hundred and fifteen patients were admitted prospectively according to the criteria within 24 hours of SAP onset. Patients were randomly assigned to either rapid hemodilution （hematocrit （HCT） 〈35%, n=56） or slow hemodilution （HCT 〉35%, n=-59） within 48 hours of onset. Balthazar CT scores were calculated on admission, day 7, and day 14, after onset of the disease. Time interval for sepsis presented, incidence of sepsis within 28 days and in-hospital survival rate were determined. Results The amount of fluid used in rapid hemodilution was significantly more than that used in slow hemodilution （P 〈0.05） on the admission day, the first day, and the second day. There were significant differences between the rapid and slow hemodilution group in terms of hematocrit, oxygenation index, pH values, APACHE II scores and organ dysfunction at different time during the first week. There were significant differences in the time interval to sepsis in rapid hemodilution （（7.4±1.9） days） compared with the slow hemodilution group （（10.2±2.3） days）, and the incidence of sepsis （78.6%） was higher in the rapid group compared to the slow （57.6%） in the first 28 days. The survival rate of the slow hemodilution group （84.7%） was better than the rapid hemodilution （66.1%. P 〈0.05）. Conclusions Rapid hemodilution can increase the incidence of sepsis within 28 days and in-hospital mortality. Hematocrit should be maintained between 30%-40% in the acute response stage.
