The influence of acute normovolemic hemodilution blood transfusion on postoperative delirium in patients undergoing cardiopulmonary bypass

Zhang Zexin; Wu Ziyi; Yao Hao

doi:10.13498/j.cnki.chin.j.ecc.2024.03.06

Abstract：Objective To investigate the effect of acute normovolemic hemodilution(ANH)blood transfusion on postoperative delirium(POD)in patients after cardiac valves surgery undergoing cardiopulmonary bypass.Methods 60 consecutive patients undergoing cardiac valve surgery with cardiopulmonary bypass between September 2021 and December 2022 were selected.They were randomly divided into ANH group and control group.Patients in ANH group were received whole blood from patients by connecting a blood storage bag containing sodium citrate anticoagulant via a right internal jugular three lumen central venous catheter under general anesthesia,relying on gravity action to collect their whole blood,and reinfused before the end of the procedure,while patients in control group were treated according to routine procedures.Before surgery(T1),at the end of cardiopulmonary bypass(T2),and at the end of the operation(T3),5 ml of whole blood was obtained from the patient,and the serum was tested for interleukin-1β(IL-1β)、Interleukin-6(IL-6),Interleukin-10(IL-10)、free hemoglobin(FHb),as well as bispectral index(BIS).The intraoperative low cerebral oxygen saturation,POD,postoperative ICU stay time,tracheal intubation time,24h pericardial and mediastinal drainage volume,perioperative blood product transfusion volume,postoperative vasoactive drug use were recorded.Results The incidence of POD in acute normovolemic hemodilution group was lower than that in control group(P<0.05).The concentrations of IL-1β,IL-6 and FHb in acute normovolemic hemodilution group were lower than those in control group at T2 and T3.The result of bispectral index in ANH group was lower than that in control group at T3(P<0.05).The WBC,C-reactive protein,lactate value,drainage volume,blood product infusion volume,tube time and ICU stay time in ANH group were all lower than those in control group,24 h after operation(P<0.05),and the use of vasoactive drugs was also significantly reduced(P<0.05).Intraoperative hypoxic saturation and other clinical results were not significantly different between the two groups(P>0.05).Conclusion Acute normovolemic hemodilution blood transfusion can reduce the incidence of POD in patients undergoing cardiopulmonary bypass.The reason may be related to reducing the concentration of inflammatory factors and FHb in patients,as well as reducing the input of blood products and the use of vasoactive drugs after surgery.