万汶与贺斯在失血性休克容量复苏中影响凝血功能的对比研究

Comparative analysis on Voluven and HES of their respective blood coagulation functionality of fluid resuscitation of hemorrhagic shock

目的在应用传统液体复苏方法和限制性液体复苏方法治疗创伤所致的未控制性失血性休克中，比较万汶与贺斯两种复苏液体对患者凝血功能的影响。方法选择160例非控制HTS患者，随机分为传统液体复苏组和限制性液体复苏组，再将每组随机分为万汶亚组（V）和贺斯亚组（H），分别应用万汶、贺斯对相应亚组患者行胶体液复苏。液体复苏后30min、1h、2h检测红细胞比积（hematocrit，Hct）、血小板计数（Platelet count，PLT）、凝血酶时间（thrombin time，TT）、血浆凝血酶原时间（prothrombin time，PT）、活化部分凝血酶原时间（activated partial thromboplastin time，APTT）、纤维蛋白原（fibrinogen，FIB）。结果①传统液体复苏组输入液体总量大于限制性液体复苏组输入液体总量（P〈0．05）。②随时间的延长，两组的HCT、PIJrr进行性下降；在限制性液体复苏组2h检测显示，v亚组PLT高于H亚组（P〈0．05）；在传统液体复苏组1h、2h检测均显示v亚组PLT高于H亚组（P〈0．05）。③随时间的延长，两组的TT、PT、APTT升高，FIB下降；在限制性液体复苏组2h检测显示，V亚组的APTT及TT均低于H亚组（P〈O．05）。结论万汶应用于失血性休克容量复苏中较贺斯对凝血功能影响小，当应用限制性液体复苏方法时，这种优势更加明显。

Objective To compare their respective effect in the blood coagulation functionality while the application of limited fluid resuscitation method and traditional method of fluid resuscitation were offered in treating the uncontrollable hemorrhagic traumatic shock （HTS）. Methods 160 uncontrollable HTS patients were randomly divided into two groups, the limited fluid resuscitation and the traditional fluid resuscitation. Then each group was again divided into two subgroups respectively, Voluven （V） and HES （H）, and Voluven and HES were adopted in their respective groups accordingly. The following indicators were observed in 30 minutes, one hour, and two hours after the fluid resuscitation completed： whole blood hematocrit （HCT）, platelet count （PLT）, thrombin time （TF）, prothrombin the original time （PT）, part of the activated thromboplastin time （APTT）, and fibrinogen （FIB）. Results The total content infused in traditional fluid resuscitation group was greater than that in limited fluid resuscitation group （P 〈0.05）. Two groups＇ HCT and PLT decreased as time went. PLT in V subgroup was higher than H subgroup in the limited fluid resuscitation group （P 〈0.05）. Yet, on the hour observation of one hour and two hours of the traditional fluid resuscitation group, PLT in V subgroup was higher than that in H subgroup （P 〈0.05）. The two groups＇ TT, PT, and APTT were increased while FIB was decreased when the time went. On the hour of two hours＇ observation, V subgroup＇ s APTT and TT were lower than those in H subgroup in the limited fluid resuscitation group with no exception （P 〈0.05）. Conclusion Voluven is less effective to the coagulation than HES in treating hemorrhagic shock, yet its superiority is obvious in the limited fluid resuscitation.