6%羟乙基淀粉血液稀释对患者凝血曲线和凝血功能的影响

Effect of acute normovolemic hemodilution with 6% hydroxyethyl starch on clotting and platelet function curves in patients.

目的 探讨 6 %羟乙基淀粉急性等容性血液稀释 (ANH)对患者凝血曲线和凝血功能的影响。方法 选择ASAⅡ～Ⅲ级全麻下神经外科手术患者 2 0例 ,在麻醉后手术前采血 (1 5ml/kg) ,同时等速输入等量的 6 %羟乙基淀粉。检测血常规、凝血酶原时间 (PT)、部分凝血活酶时间 (APTT) ;观察凝血液体时相 (SonACT)、信号达峰时间、凝血速率、最大凝血信号变化。结果 ANH后 ,红细胞压积 (Hct)、血红蛋白、红细胞计数均明显下降 (P <0 .0 5 ) ,达到中度血液稀释标准 (Hct0 .2 5～ 0 .30 ) ;PT明显延长、血小板显著降低 (P <0 .0 5 ) ,但仍在正常范围内 ;SonACT、信号达峰时间、凝血速率和最大凝血信号均无显著性变化 (P >0 .0 5 )。自体血回输后 ,所有检测值和稀释后相比 ,差异无显著性 (P >0 .0 5 )。

Objective To study the effect of moderate acute normovolemic hemodilution (ANH) with 6% hydroxyethyl starch on clotting and platelet function curves in patients.Methods 20 ASA Ⅱ～Ⅲ adult patients undergoing neurosurgical procedure were selected. 15 ml/kg auto donation blood was withdrawn in all patients immediately after anesthesia and before operation, simultaneously equal volum of 6% hydroxyethyl starch was infused at same rate. Routine items of blood, PT, APTT were examined. The changes of SonACT, TTP, clot rate, MCS were observed.Results After ANH, the values of Hct, Hb and RBC were significantly decreased ( P < 0.05 ). PT was significantly prolonged and PLT counts were significantly decreased, but they could be maintained in normal range. The SonACT and TTP were increased and clot rate, MCS were decreased mildly, but differences were not significant. Changes of all measured values showed no significant difference compared with those after ANH when auto donation blood transfusions were done.Conclusion The effects of moderate ANH on clotting and platelet function curves were slight.