Preoperative acute hypervolemic hemodilution with hydroxyethylstarch: An alternative to acute normovolemic hemodilution?

被引:53
作者
Mielke, LL [1 ]
Entholzner, EK [1 ]
Kling, M [1 ]
Breinbauer, BEM [1 ]
Burgkart, R [1 ]
Hargasser, SR [1 ]
Hipp, RFJ [1 ]
机构
[1] TECH UNIV MUNICH,KLINIKUM RECHTS ISAR,ORTHOPAD KLIN & POLIKLIN,D-81675 MUNICH,GERMANY
关键词
D O I
10.1097/00000539-199701000-00005
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Acute normovolemic hemodilution (ANH) may help to reduce demand for homologous blood but requires extra time and apparatus. A more simple procedure is acute hypervolemic hemodilution (HHD), where hydroxyethylstarch is administered preoperatively without removal of blood. In a prospectively randomized study we compared ANH (preoperatively 15 mL/kg autologous blood removal and replacement with 15 mL/kg of hydroxyethylstarch with HHD (15 mL/kg of hydroxyethylstarch administered preoperatively) in 49 patients undergoing hip arthroplasty. To avoid excessive intravascular volume, we used the vasodilating effect of isoflurane. No significant differences were found between groups (ANH, n = 23; HHD, n = 26) for intraoperative blood loss (ANH versus HHD, median [minimum-maximum]); 545 [295-785] mL versus 520 [315-825] mL) and postoperative blood loss (730 [525-945] mL versus 780 [495-895] mL), postoperative hemoglobin, hematocrit, platelet count or coagulation variables, and transfusion requirements (ANH 43% versus HHD 35% of patients received homologous blood) (P > 0.05). Heart rate did not change significantly in either group. In the ANH group mean arterial blood pressure (MAP) decreased after hemodilution (P < 0.05) while in the HHD group MAP did not change over time. Mean time required to preform ANH was 58 (46-62) min versus HHD 16 (12-19) min (P < 0.05). Costs for ANH were $63.60 USD and for HHD $32.75 USD (labor costs not included). In orthopedic patients undergoing hip replacement with a predicted blood loss of about 1000 mL, HHD seems to be a simple as well as time- and cost-saving alternative for ANH.
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页码:26 / 30
页数:5
相关论文
共 28 条
  • [1] BLUMBERG N, 1990, Transfusion Medicine Reviews, V4, P24, DOI 10.1016/S0887-7963(90)70239-8
  • [2] BOLDT J, 1990, ANAESTHESIST, V39, P6
  • [3] THE RISK OF TRANSFUSION-TRANSMITTED INFECTION
    DODD, RY
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1992, 327 (06) : 419 - 421
  • [4] ENTHOLZNER E, 1992, FORTSCHR ANAESTHESIO, V2, P108
  • [5] MAXIMUM BLOOD SAVINGS BY ACUTE NORMOVOLEMIC HEMODILUTION
    FELDMAN, JM
    ROTH, JV
    BJORAKER, DG
    [J]. ANESTHESIA AND ANALGESIA, 1995, 80 (01) : 108 - 113
  • [6] GOODNOUGH LT, 1994, ANESTH ANALG, V78, P932
  • [7] INTAGLIETTA M, 1989, MICROCIRCULATORY EFF, P21
  • [8] ANESTHESIA AND BLOOD-LOSS IN TOTAL HIP-REPLACEMENT
    KEITH, I
    [J]. ANAESTHESIA, 1977, 32 (05) : 444 - 450
  • [9] KLOVEKORN WP, 1976, ANAESTHESIST, V25, P193
  • [10] A REPORT OF 104 TRANSFUSION ERRORS IN NEW-YORK-STATE
    LINDEN, JV
    PAUL, B
    DRESSLER, KP
    [J]. TRANSFUSION, 1992, 32 (07) : 601 - 606