两种羟乙基淀粉行急性高容量血液稀释对小儿血液流变学和凝血功能的影响

The influence of two different hydroxyethyl starch solutions on acute hypervolemic hemodilution in pediatric patients

目的探讨两种分子量和取代级的6％羟乙基淀粉（HES）130／0．4（万汶）和6％HES200／0．5（贺斯）行急性高容量血液稀释（AHH）对手术患儿的血液流变学、血小板和凝血功能等的影响。方法40例1～12岁的手术患儿随机分为6％HES130／0，4组（V组）和6％HES200／0．5组（H组），术前1h分别输入6％HES130／0，4或6％HES200／0，510ml／kg，测定输液前后血液流变学、血小板功能和凝血功能，并进行比较。结果两组患儿输液后全血牯度低切、中切、高切参数和红细胞压积均显著下降（P〈0．01）。V组患儿全血还原牯度低切和高切参数在输液后显著降低（P〈0．05）。V组红细胞聚集指数在输液后显著降低（P〈0．01）且与H组比较差异有显著意义（P〈0．05）；两组红细胞电泳指数在输液后显著增加（P〈0．05）。两组患儿1min血小板聚集率（PAG1）和最大血小板聚集率（PAGM）在输液前后无显著改变，但是两组间差异有显著意义（P〈0．05）。两组患儿输液后凝血酶原时间（PT）均显著延长（P〈0．01），但均在正常范围。结论两种不同分子量和取代级的羟乙基淀粉用于1～12岁患儿进行术前AHH，均改善血液流变性，6％HES130／0，4对凝血功能的影响比6％HES200／0．5更小，对血液流变学的改善更好。

Objective To compare the influence of two different hydroxyethyl starch solutions on blood rheology and coagulation changes after preoperative acute hypervolemic hemodilution in children. Methods Forty pediatric patients were randomized into group V（6% HES 130/0. 4） and group H（6% HES 200/0. 5）. Preoperative acute hypervolemic hemodilution was induced with 6 % HES 130/ 0. 4 or 6% HES 200/0. 5 10ml/kg. Blood rheology, the count and function of blood platelet and blood coagulation were measured before and after infusion. Results Blood low, middle and high shear rate viscosity was Obviously lower after infusion in two groups（P〈0. 01）. Blood low and high shear rate reduced viscosity was obviously lower in group V（P〈0. 05）. Haematocrit was obviously lower after infusion than that before in two groups（P〈0. 01）. Erythrocyte aggregation index was obviously lower after infusion in group V（P〈0. 01）, which was significantly different from that in group H. After infusion, the platelet aggregation rate was not obviously changed in group H, which was significantly different between two groups. The erythrocyte electrophoresis index was obviously higher （P〈 0. 05）, and prothrombin time was longer than that before in two groups（P〈0. 01）. Conclusion HES 130/0. 4 has the advantages in hemorheology and blood coagulation over conventional HES 200/ 0. 5 for preoperative acute hypervolemic hemodilution in pediatric patients.