摘要
目的比较非体外循环冠状动脉搭桥术(0PCAB)中临床剂量的羟乙基淀粉(HES)130／0．4和琥珀酰明胶对凝血功能的影响。方法选择24例美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级、择期行OPCAB的患者,随机均分为琥珀酰明胶组(GEL组)和HES组。分别于麻醉诱导前(T0)、术毕即时(T1)和术后24 h(T2)测定血小板计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)和D-二聚体等凝血功能指标。记录术中失血量、术后24 h内的胸管引流量和输血量。结果两组间手术时间、术中补液量、术中出血量和24 h胸管引流量的差异均无显著性(P值均>0．05)。两组间T0、T1和T2时间点的血小板计数、PT、APTT、Fib及D-二聚体的差异均无显著性(P值均>0．05)。结论临床剂量的HES 130／0．4与琥珀酰明胶对OPCAB患者凝血功能的影响无明显差异,可安全应用于OPCAB的容量治疗。
Objective To compare the influences of hydroxyethyl starch（HES） 130/0.4（Voluven） and gelatin（Gelofusine） on coagulation in patients undergoing off-pump coronary artery bypass（OPCAB）. Methods Twenty-four patients（ Ⅱ-Ⅲ grade according to ASA） undergoing elective OPCAB were randomized into two groups： In GEL group（n = 12）, gelatin was given perioperatively for volume support to keep the central venous pressure（CVP） between 7 and 14 mmHg; in HES group（n = 12）, HES 130/0.4 was administered using the same protocol as in GEL group. Measurements of standard coagulation variables were performed before the induction of anesthesia（T0 ）, at the end of surgery（T1 ）, and 24 hours after surgery（T2 ）. Results The two groups did not differ significantly with regard to operative bleeding, cumulative chest tubg drainage time within 24 hours after surgery or the use of packed red blood cells（P 〉 0.05）. Standard coagulation variables such as platelet count （Plt）, prothrombin time（PT）, activated partial thromboplastin time（APTT）, fibrinogen（Fib） and D-dimer were similar between the two groups（P 〈 0.05）. Conclusions Volume replacement with HES 130/0.4 is as safe as the gelatin with regard to coagulation in patients undergoing OPCAB.
出处
《上海医学》
CAS
CSCD
北大核心
2006年第12期862-865,共4页
Shanghai Medical Journal
