Effect of acute hypervolemic hemodilution combined with controlled hypotension on troponin I in elderly patients

Objective To investigate the effect of acute hypervolemic hemodilution(AHH) or AHH combined with controlled hypotension(CH) induced by nicardipine on troponin I(CTnI) in elderly patients,and to evaluate the feasibility in clinical use.Methods This study included thirty ASA Ⅱ patients aged 65 to 79,and undergoing selective liver cancer,hepatic hemangioma or pancreas duodenum operations during which the blood loss was expected to be over 15% of the patients' blood volume.These patients were randomly divided into two groups: group Ⅰ AHH(n=15) and group Ⅱ AHH combined with nicardipine CH(n=15).In both groups compound sodium acetate injection was infused at a rate of 10 ml/kg when the patients entered the operating room.6% hydroxyethyl starch solution(HES 200/0.5) 15 ml/kg was infused at a rate of 30 ml/min before skin incision in both groups.In group Ⅱ,nicardipine was infused at a rate of 1-4 μg/(kg·min) and MAP maintained at 70% of the preoperative level as soon as AHH began.Hematocrit(Hct),hemoglobin(Hb),MAP(mean arterial pressure),CVP(central venous pressure)were measured before AHH(T0),towards the end of AHH(T1),1h after AHH(T2) and 2 h after operation(T3).CTnI was measured at T0,T1,T3,4 h after operation(T4) and 24 h after operation(T5).During the operation,blood loss and the transfusion volume were recorded.Results(1) The two groups were comparable in the duration of operation,blood loss and transfusion volume.(2) Compared with the value at T0,Hct and Hb were decreased at T1,T2,T3 in both groups.Hct and Hb in group Ⅱ were not significantly different from those in group Ⅰ.MAP was not significantly different from the value at T0.CVP was increased in group Ⅰ while MAP was decreased and CVP was not significantly different in group Ⅱ.Compared with group Ⅰ,MAP and CVP were decreased in group Ⅱ.(3) CTnI was not significantly different during and after operation in both groups.Conclusions AHH or AHH combined with CH induced by nicardipine used for treating elderly patients without cardiac and puhnonary diseases have little influence on myocardial function.