Effects of acute hypervolumic hemodilution with 6％ hydroxyethyl starch (130/0.4) on glycometabolism in patients with posterior lumbar decompression and bone graft fixation

Abstract

Objective To investigate the effects of acute hypervolumic hemodilution (AHH) with 6％ hydroxyethyl starch (130/0.4) on glycometabolism in patients with posterior lumbar decompression and bone graft-fixation. Methods Sixty ASA Ⅰ -Ⅱ selective surgery patients were randomly divided into three groups(n=20): control group (group A), Ringer's solution group (group B) and voluven group (group C). In group B and C, 15 ml/kg Ringer's solution or voluven were infused respectively in 20 min-30 min after induction of anesthesia. The hemodynamics were continuously monitored in three groups. Blood samples were taken and the level of Hb, Hct, glucose(glu), cortisol(cor), glucagon(gln) and insulin(ins) were examined at different time points: prior to the AHH (T1), AHH finished immediately (T2), after surgery (T3), and 2 h after surgery (T4). Also the HOMA-insulin resistance index (HOMA-IRI) and insulin sensitivity index(ISI) were calculated. Results The hemodynamics of B and C groups remained stable at T2 compared with that at T1, but the level of glu, cor, gln and ins declined. At T3 and T4 in group A and B Hb, Hct and ISI significantly decreased(P＜0.05). Glu(11.6±2.3) mmol/L, ins(11.2±2.5) mIU/L, cor(347±39) μg/L, gln (230±19) ng/L and IRI increased markedly (P＜0.05). There were significant changes of glu, cor, gln, ins, IRI and ISI at T1. At T3 and T4 in group C, glu (8.0±2.0) mmol/L, ins (8.5±2.3) mIU/L, cot (282±21) μg/L, gln (197±28) ng/L and IRI elevated to a less degree than that observed in group A and B (P＜0.05). ISI decreased slightly in group C at post operation compared with that in other two groups (P＜0.05). Conclusion Implemented AHH with voluven before surgery can reduce posterior lumbar decompression and bone graft in patients with the concentration of stress hyperglycemia, cortisol, glucagon and insulin resistance. Key words: 6％ hydroxyethly starch; Hemodilution; Blood glucose; Glycometabolism