两种血浆制剂及10%羟乙基淀粉对人体凝血和纤溶功能的影响

Effect of solvent/detergent-treated plasma(SDP)on coagulation and thrombelastogram in patients undergoing surgery

目的比较冰冻病毒灭活血浆(S/D血浆)、新鲜冰冻血浆及10%羟乙基淀粉对机体凝血、纤溶功能的影响。方法60例接受四肢、脊柱手术,并估计失血量在500mL以上的择期手术患者,年龄18~60岁。分段法随机分为3组:S/D血浆组(SDP组,n=20)、普通新鲜冰冻血浆组(FFP组,n=20)、10%羟乙基淀粉组(HES组,n=20)。所选择患者均采取全身麻醉方式,术中连续监测直接桡动脉血压、心电图、脉搏氧饱和度、呼气末二氧化碳分压、间断监测中心静脉压。在失血量达400~500mL时开始在各组输注实验药物,输注量为8~10mL/kg,在60min内输注完毕,术中根据红细胞压积(HCT)考虑是否输注红细胞。各组在输注实验药物前、输注完毕后60min、输注完毕后120min采集血样,检测AT-Ⅲ、PC、D-D、t-PA、PAI。采用SPSS11.0软件对各组间进行重复测量的方差分析法处理,P<0.05为差异有统计学意义。结果HES组蛋白C及AT-Ⅲ含量在输注后下降(P<0.05)。SDP组在输注后血浆内蛋白C含量明显下降(P<0.05),FFP组输注前后差异无统计学意义(P>0.05)。SDP组及FFP组在输注前后体内AT-Ⅲ含量无明显改变(P>0.05)。D-D:SDP组、FFP组于输注后呈明显增高趋势(P<0.05);HES组输注前后无明显改变(P>0.05)。t-PA:SDP组、FFP组在输注后逐渐增高,直至输注后120min较输注前增高明显(P<0.05);HES组输注后60min明显下降(P<0.05),而在120min后恢复至输注前水平(P>0.05)。PAI-1:FFP组输注前后均无明显改变(P>0.05),SDP组在输注后120min明显升高(P<0.01);HES组在输注后60、120min明显升高(P<0.01)。结论SDP及FFP输注后明显改善机体抗凝血功能并且优于HES组,二者效果相似。SDP对于维持机体失血后凝血与纤溶功能的平衡,防止凝血物质过度消耗上较FFP及HES更为理想。

Objective To investigate the effect of solvent/detergent-treated plasma（SDP）on coagulation in patients undergoing surgery. Methods Sixty ASA Ⅰ -- Ⅱ patients （aged 18--60 years and weighing 52--69kg） undergoing elective abdominal or spinal surgery under general anesthesia were randomly divided into three groups：when the blood loss≥500mL,20 patients receiving SDP （SDP group）, 20 receiving fresh frozn plasma（FFP group） and 20 receiving 10% hydroxyethyl starch （HES group）. During the process of operation the blood volume of the patients was maintained at normal level through infusing Lactic acid Ringer＇ solution, and red blood cells were infused if necessary. Perioperative blood pressure, electrocardiogram（ECG）, Oxygen saturation（SO2 ）, expirated partial pressure of carbon dioxide （ETCO2）,and central venous pressure（CVP） were monitored. Blood sample was collected from the central vein before infusion,60 minutes and 120 minutes after infusion respectively. And PC,D-D,t-PA,PAI-1 and the an- tibody of virus were measured. Samples of SDP and FFP were collected after infusion. Results After infusion,AT-Ⅲ and Protein C decreased significantly in the HES group（P^0.05） ,and Protein C decreased significantly in the SDP group（P《0.05）. However＇no significant differences in Protein C and AT-Ⅲ in the FFP group（P〉0.05） or in AT-Ⅲ in the SDP group（P〉0.05） before and after infusion. After infusion, D-Dimer increased in group of SDP and FFP（ P〈0. 05）, but no significant difference in D-Dimer before and after infusion was found in the HES group（P〉0.05）. After infusion,t-PA increased significantly in group of SDP and FFP （P 〈0.05） ,and in the HES group,t-PA increased significantly at 60minutes after infusion and recovered to the pre-infusion level at 120minutes after infusion. PAI-1 increased significantly at 120 minutes after infusion in the SDP group（P〈0.05） ,increased significantly, at 60 minutes and 120 minutes after infusion in the HES group（P〈0.05）, but no significant difference was found before and after infusion in the FFP group（P〉0.05）. Conclusion The effects of SDP and FFP on anti-coagulation are better than HES, while similar effect is found between SDP and FFP. Infusion of SDP helps to balance coagulation and fibrinolyiss,and the effect of SDP in reducing consumption of coagulation materials is superior to FFP and to 10% HES in patients undergoing surgery.