不同羟乙基淀粉对心肺转流血液循环和凝血功能的影响

Effcet of hydroxyethyl starch with different molecular weight and degrees of substitution on circulation and coagulation during cardiopulmonary bypass

目的比较不同分子量和取代级羟乙基淀粉(6%羟乙基淀粉200/0.5和6%羟乙基淀粉130/0.4)对心肺转流患者血流动力学、血液流变学和凝血功能的影响。方法选择60例行房间隔缺损修补术和(或)室间隔缺损修补术患者,随机分为两组(n=30):6%羟乙基淀粉200/0.5组(A组)和6%羟乙基淀粉130/0.4组(B组)。A组预充6%羟乙基淀粉200/0.5800ml和复方乳酸钠400ml,B组预充6%羟乙基淀粉130/0.4800ml和复方乳酸钠400ml。分别于诱导前(基础状态)、CPB15min、鱼精蛋白中和肝素后10min、术毕时监测患者血流动力学参数(HR、MAP、CVP)和血液流变学参数(全血高、低切粘度,血浆粘度),并同时抽血检测凝血功能(PT、APTT、FIB、ACT、Plt)。结果与基础值比较,两组在转流后全血高、低切粘度和血浆黏度明显下降(P<0.05),PT、APTT均有所延长(P<0.05),FIB、Plt均有所减少(P<0.05),HR、MAP、CVP、ACT差异无统计学意义(P>0.05)。两组组间各时点血流动力学、血液流变学和凝血功能指标差异均无统计学意义(P>0.05)。结论 6%羟乙基淀粉200/0.5或6%羟乙基淀粉130/0.4作为CPB预充液,均可维持血流动力学稳定,改善微循环,但对凝血功能有可耐受的影响。

Objective To compare the effects of 6% hydroxyethyl starch 200/0.5 （6% HES200/0.5） and 6% hy- droxyethyl starch 13 0/0.4 （6% HES 130/0.4） on haemodynamics, hemorheology and coagulation fimction during cardiopulmonary bypass. Methods Sixty adult patients undergoing repair of atrial septal defect and （or） ventricular septal defect were randomly divided into two groups, each with 30 cases： 6% HES200/0.5 group （group A） and 6% HES：300/0.4 group （group B）. In group A, the priming fluid was 800 ml 6% HES200/0.5 and 400 ml lactated Ringer＇s solution. In group B, the priming fluid was 800 ml 6% HES：30/0.4 and 400 ml lactated Ringer＇ s solution. Haemodynamics parameters （HR, .MAP and CVP）, hemorheology parameters （whole blood viscosity and plasma viscosity） and coagulation parameters （PT, APTT, FIB, ACT and Plt） were evaluated before induction of anesthesia （baseline）, at 15 rain of CPB, at 10 rain after protamine injection, and at the end of operation. Results Whole blood viscosity, plasma viscosity, FIB and Plt were significantly lower （P〈0.05）, while PT and APTT were significantly higher after CPB （P〈0.05）, compared with that before induction of anesthesia. There were no significant differences in HR, MAP, CVP and ACT after CPB （P〉 0.05）. No significant differences were found between the two groups in terms of hacmodynamics, hemorheology and coagulation function. Conclusion 6% HES200/0.5 or 6% HES130/0.4 can maintain hacmodynamics stabile and improve mi- crocirculation during cardiopulmonary bypass, but both of them can impact coagulation function, although the parame- ters are still in normal range.