两种血浆代用品对创伤性休克患者电解质及凝血功能的影响比较

Comparison on impacts of succinylated gelatin and hydroxyethyl starch on the blood coagulation and electrolyte in patients with traumatic shock

目的探讨琥珀酰明胶和羟乙基淀粉对创伤性休克患者电解质及凝血功能影响。方法选择106例患者,分为琥珀酰明胶组和羟乙基淀粉组各53例,琥珀酰明胶组输入琥珀酰明胶1000 ml,羟乙基淀粉组输入羟乙基淀粉1000 ml,速度均为20 ml/kg.h,比较麻醉前、扩容开始、扩容进行15 min以及扩容结束后10 min患者电解质和凝血功能,以及扩容前后血红蛋白和血小板的变化。结果在上述三个时点琥珀酰明胶组Ca2+无显著性变化(P>0.05);羟乙基淀粉组在扩容进行15 min开始,Ca2+即显著低于麻醉前和扩容开始时(P<0.05);两组PT在扩容进行15 min开始快于麻醉前和扩容开始时(P<0.05),两组扩容结束后10min血小板和血红蛋白值即均较前显著延长(P<0.05)。结论琥珀酰明胶对维持创伤性休克患者电解质平衡方面优于羟乙基淀粉,两者对凝血功能无显著影响,快速大量输入能为等待成分输血争取时间。

Objective To investigate the influences of succinylated gelatin and hydroxyethyl starch on the blood coagulation and electrolyte in patients with traumatic shock （TS）. Methods The 106 patients with TS were divided into two groups： sueeinylated gelatin （gelofusion） group （n=53） and hydroxyethyl starch group （n=53）; succinylated gelatin group was injected gelofusion 1000ml, hydroxyethyl starch group received the starch 1000 ml, the dosages of two groups all were 20ml/kg; the expansion changes in hemoglobin and platelets before anesthesia, the expansion began, expansion for 15 min as well later 10min after expansion electrolytes and coagulation function in the patients were detected. Results At above-mentioned time-points Ca2~ of gelofusion group had no significant difference （P〉0.05）, while in hydroxyethyl starch group from the expansion lasted for 15 min Ca2~ just begun to decrease significantly （P〈0.05）; in both groups from the expansion lasted for 15 min the PT begun faster than before anesthesia and expansion begining （P〈0.05）, 10 rain after expansion ending the values of hemoglobin and platelet significantly all prolonged （P〈0.05）. Conclusion In maintaining electrolyle balance of TS patient gelofusion has less impact than hydroxyethyl starch; but the two agents have no influence on coagulation function; And rapid and massive transfusion could be useful to wait the time for injecting component blood.