羟乙基淀粉130／0．4和聚明胶肽急性高容量血液稀释对脊柱手术患者凝血功能影响的比较

Comparison of effects of acute hypervolemic hemodilution with hydroxyethly starch 130/0.4 and polygeline on function of blood clotting in patients undergoing spinal operation

目的采用羟乙基淀粉130／0．4和聚明胶肽行急性高容量血液稀释，比较其对脊柱手术患者凝血功能的影响。方法将45例患者随机分为三组，HS组、PI组和对照组，每组15例。HS组和PI组分别静脉输注羟乙基淀粉130／0．4和聚明胶肽行急性高容量血液稀释，15ml／kg，速度40ml／min，切皮前完成；对照组为常规输液；分别于麻醉诱导前（T0）和麻醉诱导后1h（T1）、术毕（T2）时采颈内静脉血4ml，检测血红蛋白（Hb）、红细胞比客（Hct）、血小板计数（PLT）、凝血酶原时间（PT）、部分凝血活酶时间（APTF）、凝血酶时间（TT）、纤维蛋白原（FIB）。结果HS组和PI组Hb、Het在T1和T2时均较T0降低（P〈0．05），组间比较差异无统计学意义（P〉0．05），但与对照组相比较显著降低，差异有统计学意义（P〈0．05）；HS组和PI组PLT和FIB在T1和T2时均较T0减少或降低（P〈0．05），三组间比较差异无统计学意义（P〉0．05）；三组胛、TT和APTT组内及组间比较差异无统计学意义（P〉0．05）。结论以羟乙基淀粉130／0．4和聚明胶肽行急性高容量血液稀释，对脊柱手术患者凝血功能无明显影响，两者差异无统计学意义。

Objective To study the effects of acute hypervolemie hemodilution （AHH） with hydroxyethly starch 130/0.4 and polygeline on function of blood clotting in patients undergoing spinal operation. Methods Forty - five patients scheduled for spinal operation were randomly divided into HS group, PI group and control group with 15 cases for each. Patients in HS group and PI group were respectively performed acute hypervolemic hemodilution by transfusing hydroxyethly starch 130/0.4 and polygeline （ 15 ml/kg） with 40 ml/min before skin incision. Patients in control group were transfused routinely. Blood samples were taken from internal jugular vein before anesthesia induction（ T0 ）, at I hour after anesthesia induction （T1 ） and te〉 mination of operation （T2 ） for determination of Hb, Hct, PLT, PT, APTT, TT and FIB. Results Hb and Hct at T1 and T2 in HS group and PI group were lower than that at TO and that in control group P 〈 0.05）, but there was no statistical difference between HS group and PI group （ P 〉 0.05 ）. PLC and FIB at T1 and T2 in HS group and PI group decreased significantly than that at TO （ P 〉 0.05 ）, while there was no statistical difference between the three groups（ P 〉 0.05 ）. PT, TT and APTT had no statistical difference within or between groups （ P 〉 0.05 ）. Conclusions Acute hypervolemic hemodilution with hydroxyethly starch 130/0.4 and polygeline has no significant effect on function of blood clotting in patients undergoing spinal operation.