羟乙基淀粉130/0.4电解质注射液等容血液稀释对老年患者肝肿瘤切除术中凝血功能的影响

Effects of normovolemic hemodilution with hetastarch starch 130/0.4 and electrolyte solution on blood coagulation during resection for liver cancer in elderly patients

目的 评价羟乙基淀粉130/0.4电解质注射液等容血液稀释对老年患者肝肿瘤切除术中凝血功能的影响.方法 拟在全麻下行择期肝肿瘤切除术老年患者40例,ASA分级Ⅱ级,年龄65 ～ 74岁,按照随机数字表法分为2组（n=20）：对照组（C组）和等容血液稀释组（NH组）.NH组在麻醉诱导后静脉输注6％羟乙基淀粉130/0.4电解质注射液行等容血液稀释,C组行常规容量管理.于麻醉诱导前（T1）、等容血液稀释后30 min（T2）、手术1 h（T3）和术毕（T4）时采集静脉血样,测定凝血功能常规指标、可溶性纤维蛋白单体复合物（SFMC）及血小板膜糖蛋白（PAC-1）的水平.结果 与C组比较,NH组术中出血量、凝血酶原时间、活化部分凝血活酶时间、SFMC及PAC-1的水平差异无统计学意义（P＞0.05）,术中异体输血量减少,T2-4时纤维蛋白原浓度下降（P＜0.05）;与T1比较,T2-4时NH组纤维蛋白原浓度下降,2组凝血酶原时间和活化部分凝血活酶时间延长（P＜0.05）,但仍在正常范围,而其他指标差异无统计学意义（P＞0.05）.结论 羟乙基淀粉130/0.4电解质注射液等容血液稀释对老年患者肝肿瘤切除术中凝血功能无明显影响,且具有一定的血液保护作用.

Objective To evaluate the effects of normovolemic hemodilution （NH） with hetastarch starch 130/0.4 and electrolyte solution on blood coagulation during resection for liver cancer in the elderly patients.Methods Forty patients,of ASA physical status Ⅱ,aged 65-74 yr,scheduled for elective resection for liver cancer under general anesthesia,were randomly divided into NH group （n =20） and control group （group C,n =20）.NH group underwent NH with 6% hematocrit starch 130/0.4 and electrolyte solution after induction of anesthesia,while group C underwent routine fluid management.Before induction of anesthesia （T1）,at 30 min after NH （T2）,at 1 h during operation （T3）,and at the end of operation （T4）,venous blood samples were collected for measurement of the routine parameters of blood coagulation,and levels of soluble fibrin monomer complex （SFMC）,and platelet membrane glycoprotein （PAC-1,platelet activation marker）.Results Compared with group C,no significant changes were found in intraoperative blood loss,PT,APTT,and levels of SFMC and PAC-1,the volume of allogeneic blood transfused was reduced,and Fib was decreased at T2-4 in NH group.Compared with the baseline value at T1,Fib was decreased significantly at T2-4 in NH group,and PT and APTT were prolonged but still within the normal range,and no significant changes were found in the other parameters in both groups.Conclusion NH with hetastarch starch 130/0.4 and electrolyte solution exerts no effect on blood coagulation during resection for liver cancer and provides blood-saving effect to some extent in the elderly patients.