中分子羟乙基淀粉对凝血和纤溶功能的影响

Effect of Medium-Molecular-Weiht Hydroxyethy l Starch on the Functions of Blood Coagulation and Fibrinolysis

目的 观察应用中分子羟乙基淀粉(6% HAES-steril) 后对机体凝血和纤溶功能的影响。方法 30例ASAI-II级的择期手术病人, 随机分为: 6% HAES-steril(HES) 组、乳酸钠林格式液(RL) 组, 每组15例, 麻醉前以20ml·kg-1·h-1的速率分别输入HES、RL60min。应用食道超声心动图动态监测心输出量(CO)、心脏指数(CI)、外周血管阻力(SVR); 输液前及输液后1h采血测定: 血红蛋白(Hb)、血细胞比容(HCT)、血小板计数(PLT)、血小板聚集实验(PAG)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB) , 组织纤溶酶原激活物(t-PA), 组织纤溶酶原抑制物(PAI-1)。结果 静脉输入大剂量HES后, 循环、纤溶功能基本稳定, HES组Hb、HCT、PLT、PAG (1)、APTT与输液前差异有显著性意义(P<0.05), 与对照组相比Hb、HCT、PLT、APTT间差异有显著性意义(P<0.05)。结论 较大剂量应用6% HAES-steril对内源性凝血因子的影响超过了血液稀释的限度, 但仍在正常值范围内。

Objective To observe the effect of blood coagulation and fibrinoglysis after infusion HAES-sterile 6%.Methods The study was performed in 30 adult patients, ASA grade Ⅰ-II, scheduled for selective surgery, which were randomly allocated to receiving intravenous infusion of hydroxyethyl starch(HES )group, lactated Ringer's solution (RL),at the rate of 20mlokg-1oh-1 in 60min,respectively,with 15 case in each group. Venous blood samples were taken before and after 1h following the infusion to deterion: hemoglobin (Hb), hematocrit (HCT), platelet count (PLT), platelet agglunation test (PAG)[involve PAG(1), PAG(5), PAG(M), T(M)], activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen(FIB), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1).Results In HES group HB, HCT, PLT, PAG(1) decreased significantly(P<0.05), APTT was prolong remarkable after infusion(P<0.05),Hb, HCT, APTT had marked different than those in the control group. In the control group, PT was lengthened remarkable (P<0.05).Conclusion Following intravenously Hydroxyethyl starch, there are no influences on the circulation and fibrinolysis. HAES-sterile 6% has significant effect on intrinsic factors of blood coagulation, but this change is inside the nor mal range.