羟乙基淀粉对体外循环血流动力学及凝血的影响

Effects of Hydroxyethyl starch on hemodynamics and coagulation during cardiopulmonary bypass

目的观察小儿心脏手术体外循环中预充6％羟乙基淀粉（Volven130／0．4）对血流动力学及凝血功能的影响。方法60例体外循环低温全麻心脏手术患儿，随机分为对照组（C组）和羟乙基淀粉组（V组），每组30例，C组在体外循环中预充血浆400ml，V组在体外循环中预充羟乙基淀粉400ml。体外循环前、后监测心率（HR）、平均动脉血压（MAP）、中心静脉压（CVP）。体外循环前、后分别抽取静脉血测定：①红细胞比容（HCT），血沉（BSR）；②血小板计数（PLC），凝血酶原时间（PT），激活全血凝固时间（ACT）。观察术前、心肺转流15min、返回ICU时及术后24h上述指标的变化。结果两组HCT、PLC在体外循环后均显著降低，全血血沉均显著加快，两组心率、MAP、CVP、PLC、ACT、PT体外循环前、后差异均无统计学意义（均P〉0．05）。结论6％羟乙基淀粉血液稀释用于小儿心内直视手术安全有益。

Objective To observe the effects of 6% hydroxyethyl starch （Volven 130/0.4） infusion on hemodynamies and coagulation. Methods 60 cases of open heart surgical children under eardiopulmonary bypass were randomly divided into two groups （ 30 cases for each ） ： The control group （ group C ） were infused with 400 ml plasma and volven group （ group V ） were infused with 400 ml Volven before eardiopulmonary bypass. Then mean aterial pressrue （ MAP）, heart rate （ HR） , and central venous pressure （ CVP） were measured. The venous blood samples were collected before and after infusion for the measurements of the following parameters-haematocrit（HCT） , blood sedimentation （BSR） , platelet count （ PLC ） , prothrombin time （ PT ） , and activated whole blood clot time （ACT）. Those indexes before operation, 15 rain after bypass, after returning to ICU, and 24 bours after operation were observed. Results HCT and PLC after infusion were significantly lower than that before infusion. BSR after infusion was significantly faster than that before infusion. There were no significant changes in MAP, HR, CVP, PLC, ACT and PT. Conclusion 6% Hydroxyethyl starch infusion is safe and beneficial during cardiopulmonary bypass.