Abstract:

AIM: To observe the effects of preoperative acute normal volemic hemodilution (ANH) and acute hypervolemic hemodilution (AHH) on coagulation and liver function in the elderly patients undergoing hepatic carcinectomy. METHODS: Forty-five ASA Ⅱ liver cancer patients (sixty to seventy years old) undergoing scheduled elective hepatic carcinectomy were randomly divided into ANH group(group A, n=15), AHH group (group B, n=15) and the control group (group C, n=15). After tracheal intubation, ANH was performed by letting blood from the jugular vein at the rate of 200-300 mL/10 min and infusing the same volume Voluven (130/0.4) in group A，AHH was performed by infusing 15-20 mL/kg Voluven (130/0.4) at a rate of 30 mL/min in group B，and group C were infused lactated Ringer's solution routinely. Blood routine(Hb, Hct), liver function（TP, ALB, AST, ALT）and coagulation function(PT, APTT, TT, DD) were observed and compared before anesthesia (T1)，30 minutes after ANH/AHH (T2) ，end of operation (T3) and 24 hours after operation (T4) in group A and B, and the corresponding time in group C. RESULTS: The blood loss volume was similar in the three groups during operations．There was significant difference in the allogeneic blood transfusions between both of the hemodilution groups and the control group（P<0.05）．Compared with T1，the Hb and Hct decreased significantly after hemodilution in group A and B．The plasma protein also significantly decreased after ANH and AHH in group A and B as compared with T1．ALT，AST in each group increased significantly during operation（P<0.05），in T3 and T4 there was significant difference between the group A and C. PT and APTT in group A and B after hemodilution were significantly prolonged (P>0.05), but none of them shifted outside the normal range．No significant changes were found in D-dimer and TT in group A and B．CONCLUSION: ANH or AHH is relatively safe during hepatic carcinectomy for elderly liver cancer patients without cardiac and pulmonary disease．ANH or AHH with 6% hydroxyethyl starch could be well applied to the elderly patients and also decrease allogeneic blood transfusions, with no apparently impact on the blood routine, liver and coagulation function．

Key words: hemodilution, hepatectomy, the blood routine, liver function, coagulation function