琥珀酰明胶急性高容性血液稀释在儿科病人的应用

Acute hypervolemic hemodilution with Gelafundin in pediatric patients

目的研究琥珀酰明胶用于婴幼儿和儿童对于血液流变学、血小板功能和凝血功能等的影响。方法20例手术病人按年龄分为婴幼儿组(I组<3岁n=9)和儿童组(C组,3—12岁n=11),术前用琥珀酰明胶10ml/kg行高容性血液稀释,输液前后分别抽取颈静脉血测定血液流变学,血小板功能和凝血功能,比较各组输液前后以及两组之间的变化。结果两组病人输液后全血低切、中切和高切粘度均显著下降(P<0.01),但血液粘度无显著改变;两组病人血细胞比容、纤维蛋血原在输液后均显著下降(P<0.01);红细胞聚集指数、刚性指数、变形指数在输液前后无显著变化,与输液前比较,输液后红细胞电泳指数显著增加(P<0.05);两组病人血沉、血小板计数和血小板聚集率、部分凝血活酶时间在输液后无显著变化;C组病人输液后凝血酶原时间显著延长。两组间各项指标相同时点比较虽有一定变化,但无显著差异(P<0.05)。结论琥珀酰明胶用于1～12岁儿科病人进行术前急性高容性血液稀释,能改善血液流变性,稳定血液动力学,但对凝血功能无影响。不增加出血倾向。

Objective To investigate the bleod rhedlogy and coagulation changes after preoperative acute hypervolemic hemodilution （AHH） with Gelafusine starch in children. Methods Twenty pediatric patients were divided into group Ⅰ （〈3 years old n=9）and group C （3-12 years old n=11）. Preoperative acute hypervohmie hemedihtion was induced by Gelafusine 10ml/kg. Blood rheology, the count and function of blood platelet and blood coagulation were measured before and after AHH. Results Blood low, middle and high shear rate viscosity were obviously lower after AHH in two groups. （P〈0.01）, meanwhile plasma viscosity and blood low, middle and high shear rate reduced, viscosity had no significant changes. Haematocrit and fibrinogen concentration were obviously lower after AHH than those before in two groups （P〈0.01）. There were no significant changers in blood sedimentation, erythrocyte aggregation, stiff and deformability index, and platelet count and aggregation rate, activated partial thrombeplastin time after AHH in two groups . After AHH, the erythrocyte electrephoresis index was obviously higher than that before（P〈0.05）, and prothrombin time was longer than that before in group C. Conclusions preoperative AHH with Gelafusine in pediatrie patients can improve blood rheology without significant effects on blood eoagalation.