6%羟乙基淀粉对体外循环心内直视手术患儿血液动力学及凝血功能的影响

Effects of Hydroxyethyl starch infusion on blood dynamics and coagulation during cardiopulmonary bypass in children

目的观察6%羟乙基淀粉对体外循环心内直视手术患儿血液动力学及凝血功能的影响。方法将60例体外循环低温全麻心脏手术患儿随机分为观察组和对照组各30例,于体外循环中分别预充羟乙基淀粉400 ml和血浆400 ml。术前、心肺转流15 min、返回ICU、术后24 h观察两组心率(HR)、平均动脉血压(MAP)、中心静脉压(CVP)、红细胞压积(HCT)、全血沉降率(BSR)及血小板计数(PLT)、凝血酶原时间(PT)、激活全血凝固时间(ACT)变化。结果与术前比较,两组HCT、PLT、MAP在心肺转流15 min均显著降低,BSR显著加快(P<0.05);心肺转流15 min和返ICU时观察组BSR显著高于对照组(P<0.05);两组HR、CVP、PLT、ACT、PT各时间点无显著差异。结论6%羟乙基淀粉作为小儿体外循环稀释液用于小儿心内直视手术效果确切、安全性高。

[ Objective ] To observe the effects of hydroxyethyl starch infusion on blood dynamics and coagulation. [ Methods ] 60 case of open heart surgical children under cardiopulmonary bypass were randomly divided into two groups： patients from VOLVEN group were infused with 6% Volven （130/0. 4） 400 ml before cardiopulmonary bypass： patients form blood plasma group were infused with bood plasma 400 ml before cardiopulmonary bypass. Mean arterial pressrue （MAP） ,heart rate （HR） and center venous pressure（CVP） were measured before and after infusion. The venous blood samples were collected before and after infusion for measurements of the following parameters ： （ 1 ） haematocrit; blood sedimentation; （2）platelet count; prothrombin time（ PT）; activated whole blood clot time （ACT）. Observed those indexes pre-operation 15 min after bypass, after ICU , 24 hours after operation. [ Results ] Haematocrit after infusion was significantly decreased than that before infusion. Blood sedimentation after infusion was significantly increased than that before infusion. There were no significant changes in MAP, HR, CVP, PLC, ACT and PT. [ Conclusion ] Hydroxyethyl starch infusion is a safe method during cardiopulmonary bypass.