羟乙基淀粉200/0.5血液稀释对不同血型患者凝血功能的影响

Coagulation changes in patients of O and non-O blood group after acute hemodilution with 6% hydroxyethyl starch

目的观察6%羟乙基淀粉200/0.5行高容量血液稀释对O型血与非O型血患者凝血功能的影响。方法选取全麻手术患者30例,按血型分为O组和非O组。所有患者在输液前(T0)、输液后即刻(T1)及输液后1h(T2)检测凝血功能相关指标。结果O组患者T2时活化部分凝血活酶时间(APTT)长于非O组(P<0.05)。O组患者凝血因子Ⅷ活性(FⅧ∶C)3个时间点均低于非O组(P<0.05);O组患者von Willebrand因子(vWF)浓度T0和T1时低于非O组(P<0.05)。O组T2时玻璃珠激活全血凝固时间(gbACT)较非O组长(P<0.05)。结论O型血患者的FⅧ∶C及vWF浓度基础值低于非O型血患者。血液稀释对O型血患者的凝血影响大于非O型患者,FⅧ∶C和vWF浓度的下降是重要原因。以6%羟乙基淀粉200/0.520ml/kg行高容量血液稀释对O型血患者凝血功能仅产生轻微的影响,但提示大剂量输注可能存在风险。

Objective To evaluate the effects of acute hypervolemic hemodilution（AHH） with 6% HES 200/0.5 on blood coagulation of patients with O and non-O blood groups. Methods Thirty patients aged 18-65 years old undergoing major surgery at a risk of large amount of blood loss during operation were enrolled in this prospective, randomized double-blinded clinical study. Patients were allocated to O group and non-O group. Arterial blood samples were taken before（T0 ）, at end （T1） and 1h after AHH for the measurements of hematocrit（ Hct）, platelet count（Pit）, prothrombin time（PT）, activated partial thromboplastin time （APTT）, coagulation factor Ⅷ activity （FⅧ ： C） and von Willebrand factor. Results Compared with the baseline,Hct and Plt decreased while PT and APTT were prolonged in both groups immediately and at 1 h after fluid treatment （P〈0. 05）. APTT was longer in O group than that in non-O group[（38. 9±7.6） s vs. （35.5±6.3） s], respectively （P〈 0.05）. FⅧ ： C at To ,T1 and T2 was lower in O group than that in non-O group [-（86.1±28.8）%, （55.8±23.1）% and （60. 0±23.0）% vs. （149.1±52.6）%,（93.1±42.9）% and （125.9±65.0）%] （P〈0.05）. gbACT was longer in O group than that in non-O group 1 hour after fluid treatment [（134.3±28.2） s vs. （127.1±25.6） s], respectively （P〈0.05）. Conclusion FⅧ ： C and vWF concentrations are lower in patients of O blood group than those of non-O group. Our study suggested that acute hemodilution with hydroxyethyl starch 200/0. 5 may interfere with coagulation in patients of O blood group much more than in those of non-O group. When using large dose hydroxyethyl starch 200/0.5 in patients of O blood group,this effect should be considered.