不同胶体预充液对心肺转流术中患者凝血功能的影响

The Effects of Three Plasma Expanders as Priming Solution on Coagulation in Cardiopulmonary Bypass

目的 :研究不同胶体预充液对心肺转流术 (CPB)下心脏直视手术病人凝血功能的影响。方法 :36例CPB下心脏直视手术病人随机分为 3组 ,每组 1 2例。分别以人血白蛋白 (A组 )、琥珀酰明胶 (G组 )和 6 %羟乙基淀粉 (H组 )预充 ,于麻醉前 (T0 )、转流中 (T1 )、转流毕 (T2 )、术后 6h(T3)、术后 2 4h(T4 )取静脉血测定凝血功能指标 :活化的部分凝血活酶时间 (APTT)、凝血酶原时间 (PT)、纤维蛋白原 (FIB)、D 二聚体 (D D)、血小板计数 (PLC)。结果 :(1 )A组和G组T1及T2时FIB均低于T0时 (P <0 0 1 ) ,G组T3时FIB仍低于T0时 (P <0 0 5 ) ,3组T3时PT均长于T0时 (P <0 0 1 ) ,H组T3时APTT长于T0时 (P <0 0 1 ) ,A组和G组T4时FIB均大于T0时 (P <0 0 1 ) ;(2 )H组T3时PT长于A组和G组 (P <0 0 5 ) ,且H组的APTT长于A组 (P <0 0 5 ) ,A组和G组T4时FIB均大于H组 (P <0 0 5 )。结论 :人血白蛋白和琥珀酰明胶预充液对机体凝血功能的影响小于羟乙基淀粉 ;各组术后数小时内机体凝血功能尚未完全恢复 。

Objective: To investigate the effects of different colloid priming solutions (including human albumin, gelofusion,and 6% hydroxyethyl starch) on coagulation in the patients when undergoing cardiopulmonary bypass (CPB) operation.Methods: 36 patients undergoing open heart surgery with CPB were randomly divided into three groups (12 of each): human albumin group(A), gelofusion group (G), and 6% hydroxyethyl starch group (H). The venous blood samples were collected before anesthesia (T0), in 20 minutes of CPB (T1), at the end of CPB (T2), in 6 hours (T3) and 24 hours (T3) after the operation. Partial coagulation parameters (APTT,PT,FIB,FDP,D D,PLT) of the three groups were measured and compared with each other. Results: 1) Fibrinogen concentrations (FIB) of group A and group G at T1 and T2 were lower than those at T0 ( P <0 01). FIB of group G at T3 was still lower than that of T0 ( P <0 05). The prothrombin time (PT) in all groups at T3 were longer than those at T0 ( P <0 01). The activated partial thromboplastin time (APTT) of group H at T3 was longer than that at T0 ( P <0 01). The FIB of group A and group G at T4 were higher than that at T0 ( P <0 01); 2) PT of group H was longer than those of group A and group G at T3 ( P <0 05), The APTT of group H was longer than that of group A ( P <0 05) , FIB of group A and group G were higher than that of group H at T4 ( P <0 05). Conclusions: The coagulation function recovers faster using human albumin or gelofusion as priming solution than using 6% hydroxyethyl starch during CPB and the body stays in relatively high coagulation condition in the next day of the operation.