羟乙基淀粉溶液术前扩容对围术期冠心病患者血小板活化的影响

Effect of Loading Infusion with Hydroxyethyl Starch 200/0.5 or 130/0.4 Solution on Platelet Activity in Patients with Coronary Heart Disease During Perioperative Period

【目的】观察两种羟乙基淀粉(HES)溶液术前扩容对冠心病患者围术期血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)、GMP-140表达的影响。【方法】全麻下接受胆囊切除术的冠心病患者45例,心功能Ⅰ-Ⅱ级,随机分为3组(n=15):术前以10ml·kg-1剂量于30min内输注HES200/0.5(组Ⅰ)、HES130/0.4(组Ⅱ)和乳酸钠林格氏(RL)溶液(组Ⅲ)。抽取静脉血,采用流式细胞仪检测麻醉前(T0)、扩容结束后即刻(T1)、扩容结束后1h(T2)、手术结束后2h(T3)时GPⅡb/Ⅲa与GMP-140的表达。【结果】组ⅠT1、T2和T3时GPⅡb/Ⅲa表达较T0降低;与组Ⅱ、组Ⅲ比较,组Ⅰ扩容后的GPⅡb/Ⅲa表达降低(P<0.05);组ⅡT1时GPⅡb/Ⅲa表达较T0降低(P<0.05);与组Ⅲ比较,组ⅡT1和T3时GPⅡb/Ⅲa表达降低(P<0.05);组ⅢT3时GPⅡb/Ⅲa表达较T0增加;组ⅠT1、T2和T3时GMP-140表达较T0降低(P<0.05);与组Ⅱ、组Ⅲ比较,组Ⅰ扩容后的GMP-140表达降低(P<0.05);与组Ⅲ比较,组ⅡT2和T3时GMP-140表达降低(P<0.05);组ⅢT2和T3时GMP-140表达较T0增加(P<0.05)。【结论】术前采用HES溶液扩容能抑制血小板GPⅡb/Ⅲa复合物与GMP-140表达,其中HES200/0.5作用较HES130/0.4明显。此作用对避免不稳定斑块处血小板的进一步积聚,防止围术期冠心病患者病情恶化可能有一定的作用。

[Objective] To investigate the effect of loading infusion with hydroxyethyl starch 200/0.5 or 130/ 0.4 solution on platelet activity in the patients with coronary heart disease （CHD） during perioperative period. [Methods] Forty-five patients with coronary heart disease who received cholecystectomy were randomly and equally assigned into 3 groups： hydroxyethyl starch HES200/0.5 solution group （group Ⅰ ）, HES130/0.4 solution group （group Ⅱ ） and lactated Ringers＇ （RL） solution group （group In, as control group）. HES200/0.5 solution, HES130/ 0.4 solution, or RL solution were respectively infused at a dose of 10 mL·kg^-1 over a period of 30 min before surgery. Flow cytometry was used to measure the expression of GPIIb/IIIa and GMP-140 before infusion （TO）, at the end of infusion （T1）, at 1 h after infusion （T2） and at 2 h after surgery end （T3）. [Results] The expression of GP Ⅱ b/Ⅲ a and GMP-140 in group Ⅰ was decreased significantly after infusion as compared to the baseline values at TO （P 〈 0.05）. The expression of GP Ⅱ b/Ⅲa in group Ⅱ was decreased significantly after infusion as compared to that at TO （P 〈 0.05） ; Compared with group Ⅱ and group In, the expression of GP Ⅱ b/In a and GMP-140 after infusion was significantly lower （P 〈 0.05） in group Ⅰ. Compared with group In, the expression of GP Ⅱ b/Ⅲ a and GMP-140 after infusion was significantly lower in group II （P 〈 0.05）. The expression of GMP- 140 was increased significantly at T2 and 33 than that at TO in group Ⅲ （p〈 0.05）. [Conclusion] Infusion with HES solution can inhibit excessive activation of platelet in the patients with coronary heart disease during perioperative period and HES200/0.5 had the stronger effect than that of HESI30/0.4, which may prevent aggravation of the disease and ameliorate prognosis.