ObjectiveTo observe the effect of acute normovolemic hemodilution (ANH) with autologous blood transfusion (ABT) and controlled hypotension (CH) during surgery on allogeneic blood transfusion and blood coagulation function. MethodsSixty patients in our hospital from February 2012 to January 2014 were chosen as our study subjects. They underwent surgeries of grade Ⅲ to Ⅳ, and the estimated amount of bleeding during surgery was more than 400 mL. The patients were randomized into group A (ANH+CH group) and group B (control group), with 30 in each. Patients in group A were first administered a standard endotracheal general anesthesia. Then an invasive arterial blood pressure monitoring was performed and the central venous blood was taken. ANH was implemented, and CH was applied to reduce bleeding. When the procedure was almost completed, ABT was implemented. The value of hematocrit, hemoglobin, platelet, prothrombin time (PT), activated partial thranboplastin time (APTT), fibrinogen, international normalized ratio (INR), heart rate, mean arterial pressure and central venous pressure were measured and recorded at the end of blood volume collection (T1), and before ABT (T2) and after ABT (T3). When hemoglobin was lower than 70 g/L during the surgery, ABT was implemented. After surgery, no allogeneic blood transfusion was performed if hemoglobin was higher than 90 g/L. Patients in group B received routine treatment. ResultsPatients' hemodynamics maintained relatively stable during ANH+ABT+CH. Blood volume collected from patients was (408.3 ±142.1) mL; blood loss volume was (705.4±586.8) mL. Compared with group B, the amount of bleeding was significantly lower, and it was reduced by (549.2±250.2) mL. No organ damage was found. For group A, compared with those values at T0, PT, hematocrit, hemoglobin, fibrinogen, and INR were significantly different at T1 and T2 (P<0.05), but the average value was within the acceptable range which did not affect the blood coagulation function. PT, APTT, platelet, hematocrit, hemoglobin, fibrinogen, and INR were significantly different before and after autologous blood transfusion (P<0.05). Postoperative infection and non-healing wounds rate was not significantly different between the two groups (P>0.05). ConclusionThis technique of acute normovolemic hemodilution with autologous blood transfusion and controlled hypotension is a useful, efficient and cost-effective blood conservation strategy. Moderate hemodilution has no influence on blood coagulation function in patients.
ObjectiveTo systematically review the effectiveness of scalp acupuncture for treating ischemic stroke. MethodWe searched databases including PubMed, EMbase, MEDLINE, The Cochrane Library, CBM, CNKI, VIP and WanFang Data from inception to December 30th 2014 for randomized controlled trials (RCTs) on scalp acupuncture in the treatment of ischemic stroke. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 27 studies involving 2 741 patients were included. The results of meta-analysis showed that:a) As for the improvement of nervous functional deficiency, the scalp acupuncture plus drug group was superior to the drug alone group (MD=-5.33, 95%CI -6.71 to -3.96, P<0.000 01), and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group (MD=-2.11, 95%CI -3.31 to -0.91, P=0.0006). b) As for the effective rate, the scalp acupuncture group was superior to the body acupuncture group (OR=0.28, 95%CI 0.15 to 0.53, P<0.000 01), the scalp acupuncture plus drug group was superior to the drug alone group (OR=0.20, 95%CI 0.14 to 0.29, P<0.000 01), and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group (OR=0.12, 95% CI 0.02 to 0.56, P=0.008). However, there was no significant difference between the scalp acupuncture group and the drug alone group (OR=0.16, 95%CI 0.03 to 0.97, P=0.05). ConclusionScalp acupuncture appears to be an effective adjuvant therapy method for ischemic stroke, and can significantly improve the nervous functional deficiency when combined with other treatment. However, the strength of evidence is low due to high risk of bias of the included studies. More rigorous studies are needed to verify the above conclusion.