羟乙基淀粉对体外循环血动力学及凝血的影响

The effect of hydroxyethyl starch infusion on blood dynamics and coagulation during cardiopulmonary bypass in children

目的观察小儿心脏手术体外循环中预充6%羟乙基淀粉130/0.4对血液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400 ml,V组在体外循环中预充羟乙基淀粉400 ml,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15 min、回ICU、术后24 h上述指标的变化。结果2组HCT、PLC在体外循环后均显著降低(P<0.05),BSR均显著加快(P<0.05),2组HR、MAP、CVP、PLC、ACT、PT体外循环前后差异无统计学意义(P>0.05)。结论采用6%羟乙基淀粉血液稀释用于小儿心内直视手术是较安全的。

Objective To observe the effect of hydroxyethyl starch infusion on blood dynamics and coagulation in children. Methods 60 children patients who received cardiopulmonary bypass were randomly divided two group. 30 patients in Volven group were infused with 6% volven 400 ml before cardiopulmonary bypass, the other 30 patients in control group were infused with plasma 400ml before cardiopulmonary bypass. The mean arterial pressure（MAP）, heart rate（HR）, center venous pressure（CVP） were detected for both groups before and after cardiopulmonary bypass, and Hct, BSR, PLC, PT and ACT were also measured. The parameters were observed before operation, 15 min after cardiopulmonary bypass, back to ICU and 24h after operation. Results Hct and PLC were significantly lower in both groups than those before cardiopulmonary bypass, and BSR was obviously faster than that before cardiopulmonary bypass. There were no significant differences in HR, MAP, CVP, PLC, ACT and PT before and after cardiopulmonary bypass. Conclusion Hydroxyethyl starch infusion is a safe method during cardiopulmonary bypass.