Application of hemodilution combined with tranexamic acid in neurosurgical operation

Objective To study the safety and effectiveness of acute hypervolemic hemodilution (AHH) combined with tranexamic acid (TA) in neurosurgical operation. Methods Forty patients underwent selective neurosurgical operation were divided into two groups by radom digits table with 20 cases each, both groups were infused HES(130/0.4) 20 ml/kg for AHH after anesthesia, TA intravenous injection of loading 10 mg/kg, 1 mg/(kg·h) continuous infusion until the end of surgery in experimental group,only for AHH in control group. The mean arterial blood pressure(MAP), central venous pressure(CVP), heart rate (HR), pulse oxygen saturation (SpO2) were measured before AHH (T0), A HH immediately (T1), 1 h after AHH (T2), at the end of operation (T3), and in the corresponding time hemoglobin (Hb), hematocrit (Hct),prothrombin time (PT), activated partial thromboplastin time (APTT), platelet ( Plt ), fibrinogen ( FIB ) were measured; the intraoperative bleeding, blood transfusion and transfusion rate were counted in both groups.Results There was no significant difference in HR and MAP at different time between two groups (P ＞0.05),compaued with T0,CVP at T1,T2 was increased (P＜0.05),Hb and Hct at T1,T2,T3 were decreased (P＜ 0.05 ). PT and APTT at T2,T3 were longer than that at T0 in control group (P＜ 0.05 ) ;Plt at T1 ,T2,T3 was lower in control group than that at T0 in two groups (P ＜ 0.05 ), Plt at T2, T3 was obviously increased in control group compared with experimental group (P ＜ 0.01 ) ; FIB at T2, T3 was lower than that at T0 in control group (P ＜0.05). The intraoperative bleeding, blood transfusion and transfusion rate in experimental group [(650 ±560) nl, (150 ± 50)ml,30％(6/20)]were lower than those in control group [(820 ±410) ml,(380 ±290) ml,60％ (12/20)],there were significant differences between two groups (P ＜0.05).Conclusion AHH combined with TA has obvious effect of saving blood and hemodynamic stability with less influence on coagulation in neurosurgical operation. Key words: Hemodilution;  Tranexamic acid;  Blood conservation