Acute normovolemic hemodilution combined with controlled hypotension does not increase incidence of postoperative cognitive dysfunction in elderly spinal surgery patients

作者：Wang, Huan; Gao, Xinyue; Lv, Na; Tao, Qiang; Yang, Dawei; Guo, Jianrong^*

来源：International Journal of Clinical and Experimental Medicine, 2017, 10(6): 9526-9535.

• Acute normovolemic hemodilution
• controlled hypotension
• blood protection
• postoperative cognitive dysfunction
• oxygen metabolism

Objectives: This study aimed to investigate influences of acute normovolemic hemodilution (ANH) combined with controlled hypotension (CH) on hemodynamics, inflammatory factors, cerebral oxygen metabolism, MMSE score in elderly spinal surgery patients. Meanwhile the incidence of postoperative cognitive dysPOCD) was assessed. Methods: Eighty elderly patients undergoing spinal surgery were randomly divided into four groups (n = 20): Control group, ANH group, CH group and ANH + CH group (AC group). Hemodynamics was monitored at four time points, including after induction of anesthesia, immediately after ANH, 30 min after reaching target blood pressure by CH and after completion of surgery. Radial arterial and jugular bulb blood were collected for blood gas analysis and cerebral oxygenation calculations. One day preoperatively, after surgery completion, one day postoperatively and seven days postoperatively, serum levels of inflammatory factors, S-100 beta protein and NSE were detected. Meanwhile, MMSE was performed and incidence of POCD was calculated. Results: ANH combined with CH could markedly reduce blood loss and save blood, which did not interfere with changes in hemodynamics, levels of inflammatory factors, S-100 beta protein or NSE. ANH combined with CH had no significant effect on cerebral oxygen metabolism, and did not interfere with postoperative MMSE score or POCD incidence, which showed significant differences compared with alone using (P<0.05). Conclusion: ANH combined with CH does not increase the incidence of POCD, well maintains hemodynamic stability, and reduces intraoperative blood loss and allogeneic blood transfusion while having no significant effect on inflammatory cytokines or cerebral oxygen metabolism.

• 出版日期2017
• 单位中国人民解放军第二军医大学; 上海市浦东新区公利医院