羟乙基淀粉对血液流变学及凝血功能的影响

The effects of HES infusion on blood rheology and coagulation

目的 观察输注 6 %羟乙基淀粉 (HES2 0 0 / 0 5 )对病人血液流变学及凝血功能的影响。方法 30例硬膜外阻滞下手术病人 ,在硬膜外阻滞前输注贺斯 12ml/kg。输液前后分别抽取静脉血测定 :(1)全血低切、中切、高切粘度 ,红细胞比容 ,全血低切、中切、高切还原粘度 ,血沉 ,红细胞聚集指数、刚性指数、变形指数。 (2 )血小板计数 (PLC) ,血小板粘附率 (PAD) ,血小板 1分钟聚集率(PAG1)、3分钟聚集率 (PAG3 )和最大聚集率 (PAGM)。 (3)凝血酶原时间 (PT) ,凝血酶时间 (TT) ,部分凝血活酶时间 (APTT)和纤维蛋白原浓度 (Fib)。结果 输液后全血粘度高切变率、中切变率明显下降 ,全血还原粘度高切变率、血沉、红细胞刚性指数在输液后显著降低 ,血小板粘附及聚集功能、TT、APTT及Fib输液后差异无显著意义 ,只有PT显著延长。结论 静注 5 0 0～ 10 0 0ml6 %HES ,可改善血液流变性 。

Objective To observe the effects of hydroxyethyl starch(HES) infusion on blood rheology and coagulation.Methods 30 elective surgical patients under epidural blockade were infused with 6% HES(200/0.5) 12ml/kg before epidural blockade.The venous blood samples were collected before and after infusion for the measurements of the following parameters:(1)blood low,middle and high shear rate viscosity;plasma viscosity;haematocrit;blood low,middle and high shear rate reduced viscosity;blood sedimentation;erythrocyte aggugation,stiff and deformability index.(2)platelet count;platelet adhesion rate;platelet aggregation rate at 1,3 min and maximal platelet aggregation rate;(3)prothrombin time(PT);thrombin time(TT);activated partial thromboplastin time(APTT);fibrinogen concentration(Fib).Results Blood middle and high shear rate viscosity after infusion was obviously lower than that before infusion.Blood high shear rate,blood sedimentation and erythrocyte stiff index after infusion were significantly lower than those before infusion.There were no significant changes in platelet adhesion rate,platelet aggregation rate,TT,APTT and Fib.PT after infusion was obviously longer than that before infusion.Conclusion HES 500- 1*#000ml infusion could improve blood rheology and has no significant effect on blood coagulation.