Chinese Medical Sciences Journal ›› 2010, Vol. 25 ›› Issue (3): 146-150.doi: 10.1016/S1001-9294(10)60039-9

• Original Article • Previous Articles     Next Articles

Effects of Acute Normovolemic Hemodilution on Perioperative Coagulation and Fibrinolysis in Elderly Patients Undergoing Hepatic Carcinectomy

Jian-rong Guo1*, Jun Yu1, Xiao-ju Jin2, Jin-man Du1, Wei Guo1, and Xiao-hong Yuan1   

  1. 1Department of Anesthesiology, Lihuili Hospital, Medical School of Ningbo University, Ningbo 315040, China 2Department of Anesthesiology, Yijishan Hospital, Wannan Medical College,Wuhu 241001, China
  • Received:2010-02-24 Online:2010-09-20 Published:2010-09-20
  • About author:Tel: 86-574-87018725, Fax: 86-574-87392232
  • Supported by:

    Supported by Ningbo Medical Technology Foundation (200612).

Abstract: 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 (T5). Then coagulation 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 of T1, 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 at T2 and T3 compared with the level at T1 (P<0.05). Compared with control group, P-selectin was sig-nificantly lower in ANH group at T2-T5 (all P<0.05). Conclusions In elderly patients undergoing resection of liver cancer, ANH may not hamper fibrinolysis and coagulation function. It could therefore be safe to largely reduce allogeneic blood transfusion.

Key words: hepatic carcinectomy, acute normovolemic hemodilution, coagulation function, fibrinolysis

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