不同预充液对O型与非O型血剖宫产产妇血栓弹力图的影响

The effect of colloid and crystalloid preloading on thromboelastography prior to cesarean section on parturients with different blood types

目的研究晶体或胶体预充液对O型与非O型血剖宫产产妇血栓弹力图(TEG)的影响。方法择期单胎足月剖宫产产妇60例,ASAⅠ或Ⅱ级,根据血型和预充液随机分为四组:O型血复方氯化钠组(A1组,n=15),非O型血氯化钠组(A2组,n=14),O型血6%羟乙基淀粉130/0.4组(B1组,n=15),非O型血6%羟乙基淀粉130/0.4组(B2组,n=16)。分别在麻醉前和预扩容完成时抽血测定TEG和血常规。结果预扩容完成时A1、B1组Hb、Plt、最大振幅(MA)明显降低(P<0.05),B1组反应时间(R)、凝固时间(K)明显延长,α角减小,达MA 30 min后血凝块溶解率(CL30)、凝血指数(CI)降低(P<0.05),B2组MA、α角减小,CI降低(P<0.05)。6%羟乙基淀粉130/0.4和O型血存在交互作用(P<0.05)。结论 6%羟乙基淀粉130/0.4和O型血对剖宫产产妇TEG指标存在相加作用,但是凝血功能无明显改变。

Objective To study the effects of colloid and crystalloid preloading on thromboelastography（TEG） prior to cesarean section on type O and non-O blood parturients. Methods Sixty parturients, ASA Ⅰ or Ⅱ , scheduled for elective cesarean section under combined spinal anesthesia were randomly assigned to four groups according to blood types and preloading fluids： type O with Ringer＇s group （Al, n=15）, non-O with Ringer＇s group （A2, n=14）, type O with colloid group （B1, n=15）, non-O with colloid group （B2, n = 16）. When anesthesia started, 10 ml/kg fluids （Ringer＇s solution or 6% hydroxyethyl starch 130/0. 4） were infused within 20 minutes. Immediately prior to and after fluid preloading （T0 and T1 respectively） maternal blood was extracted for TEG and CBC. Record the amount of blood transfusion and detect postoperative complications including bleeding and thrombosis. Results Determination of hemoglobin and platelets： there was no statisticalIy significant difference in each group before or after preloading and compared to To, the hemoglobin and platelets in group A1 and group B1 decreased at T1 （P〈0.05）. No statistically significant differences in parameters of TEG were seen before preloading among groups. MA of T1 was significantly lower than that of To in group A1 （P〈0.05）and there was no significant difference between the indicators in group A2. Values of R and K were statistically significant longer, when MA and α angle and CL30 and CI became smaller（P〈0.05）in group 131 after preloading. MA, α angle and CI became smaller（P〈0.05）in group B2 with statistical difference after prdoading. There is negative interaction between colloid and O-blood in the MA value and the CI values（P〈0.05）. None of the parturients needed blood transfusion or suffered postoperative bleeding or thrombotic complications. Conclusion The effects of colloid or crystalloid preloading on thromboelastogram in type O or now-O blood parturient undergoing cesarean section were different. The parameters of TEG showed mild hypocoagulable when type O parturients preloaded with colloid, but from a clinical point of view, the results did not show obvious difference.