摘要
目的比较6%羟乙基淀粉130/0.4和6%羟乙基淀粉200/0.5急性扩容性血液稀释时对神经外科手术患者凝血功能的影响。方法选择行择期神经外科手术的患者40例,随机分为6%羟乙基淀粉200/0.5组(H组,n=20)和6%羟乙基淀粉130/0.4组(V组,n=20),于麻醉诱导后以500ml/30min的速度输注6%羟乙基淀粉130/0.4或6%羟乙基淀粉200/0.51500ml行急性扩容性血液稀释。于血液稀释前(T0)、输液1000m(lT1)、1500m(lT2)和血液稀释后30-60min(T3)时,取股静脉血监测凝血功能变化,包括激活凝血活酶时间(ACT)、凝血速(CR)、凝血达峰时间(TP)和血小板功能(PF)。结果在血液稀释过程中,两组血液稀释后ACT较稀释前显著缩短(P<0.05),H组在输液T1、T2和T3缩短幅度分别为18%、27%和20%,V组分别为16%、25%和21%,组间比较,差异无统计学意义(P>0.05)。两组CR均下降,和稀释前比较,差异有统计学意义P<0.05),H组各时间点分别下降17%、37%和33%,V组分别下降18%、30%和27%。组间比较,差异无统计学意义(P>0.05)。PF在稀释过程中V组下降幅度明显小于H组(P<0.05)。TP在两组之间比较,V组延长幅度较小,两组之间在T2比较,差异有统计学意义(P<0.05)。结论神经外科患者应用羟乙基淀粉溶液行急性扩容性血液稀释时,6%羟乙基淀粉130/0.4对于凝血功能的影响明显小于6%羟乙基淀粉200/0.5,临床使用更为安全。
Objective To compare the effects of hyroxyethyl starch 130/0.4 with hydroxyethyl starch 200/0.5 on coagulation during acute hypervolemic hemodilution（AHH） in neurosurgical patients.Methods T40 patients undergoing neurosurgery were allocated into hydroxyethyl starch 200/0.5 group （H,n=20） and hydroxyethyl starch 130/0.4 group （V,n=20）.Patients were infused 1 500 ml hydroxyethyl starch 130/0.4 or hydroxyethyl starch 200/0.5 respectively with 500ml/30min after the anesthesia induction.Activated cloting time（ACT）,clot rate（CR）,platelet function（PF）,time to peak（TP） were tested and recorded before infusion（T0）,at the end of infusion 1 000 ml （T1）and 1 500 ml（T2）,and 30-60 min after hemodilution（T3）,respectively.Results ACT were significantly shortened at T1,T2 and T3 in both groups （P0.05）.In H group,ACT shortened 18%,27% and 20% respectively at T1,T2 and T3.In V group,ACT shortened 16%,25% and 21% respectively.The change of ACT were no significantly difference between two groups.CR were significantly decreased after hemodilution in both groups （P0.05）.In H group,CR decreased by 17%,37% and 33%,respectively at T1,T2 and T3.In V group,CR decreased by 18%,30% and 27%,respectively.PF were also decreased after hemodilution in both groups.Decreases of PF in H group were significantly less than in V group.TP was prolonged with hemodilution in both groups.And the value of TP at T2 in H group was significantly longer than that in V group （P0.05）.Conclusion During the preoperative acute hypervolemic hemodilution with hydroxyethyl starch on the patients undergoing neurosurgery,hydroxyethyl starch 130/0.4 has less effects on coagulation versus hydroxyethyl starch 200/0.5.
出处
《海南医学》
CAS
2010年第23期1-3,共3页
Hainan Medical Journal
