预注高渗氯化钠羟乙基淀粉40注射液对凝血功能和电解质、血糖的影响

The influence of preinjecting hypertonic sodium chloride hydroxylethyl starch 40 on blood coagulation,electrolytes and blood glucose

目的探讨预注高渗氯化钠羟乙基淀粉40注射液(以下简称:高渗晶胶液)对患者凝血功能和电解质、血糖的影响。方法选择ASAⅠ或Ⅱ级,神经外科手术患者24例,所有患者均采用静吸复合麻醉。入室后局麻下行桡动脉及颈内静脉穿刺,以4ml/kg输注高渗晶胶液,30min内输注完毕,输注后60min行麻醉诱导。分别在输注高渗晶胶液前(T0)、输注高渗晶胶液完毕即刻(T1)、输注高渗晶胶液后30min(T2)、60min(T3)、气管插管即刻(T4)和气管插管后5min(T5)监测:(1)HR、MAP、CVP、SpO2等;(2)凝血酶原时间(PT)、纤维蛋白原(Fib)、部分凝血活酶时间(APTT);(3)初期凝血形成时间(ACTonset)、纤维蛋白形成速率(CR)和血小板功能(PF);(4)血清K+、Na+、Ca2+、Hct、Hb及血糖(Blu)。结果与T0时相比,CVPT3时明显升高(P<0.05)。APTT、PT于T1时开始增加(P<0.05),T2时达到高峰(P<0.05),T3时恢复正常。输注高渗晶胶液后K+浓度降低,Na+浓度升高,T1时改变最为明显(P<0.05),T3时基本恢复至基础值;Hct、Hb随着输注液体的增加逐渐降低,与T0时相比差异有统计学意义(P<0.05);各时点血糖差异无统计学意义。结论适量输入高渗晶胶液(4ml/kg)对患者术中凝血及血小板功能和电解质、血糖无明显影响。

Objective To evaluate the influence of preinjecting hypertonic sodium chloride hydroxylethyl starch 40 （HSH 40）on blood coagulation, electrolytes and blood glucose. Methods Twenty-four patients, ASA class Ⅰ or Ⅱundergoing neurosurgical procedures, received general anesthesia. HSH 40 was infused in a dose of 4 ml/kg during 30 min. MAP, CVP, HR, PT, APTT, Fib, ACT onset, CR, PF and K^＋ , Na^＋ , Ca^＋ , Hct, Hb, blood glucose were measured before infusion（T0 ）, at the end of infusion（T1 ） and 30 min（T2 ）, 60 min（T3 ） after infusion. Results Compared with To , CVP was markedly increased at T3 （P〈0.05）. APTT and PT at T1 were higher than those at To （P〈 0.05） and reached peak level at T2 ,which recovered to normal at T3. The levels of K^＋ and Na^＋ were much higher at T1 than those at To （P〈0.05）. There was no significant difference in Ca^2＋ and blood glucose between To and T1 ,T2 or T3. Conclusion HSH 40 has no any significant influence on blood coagulation, platelet function, electrolytes and blood glucose.