中分子羟乙基淀粉200/0.5溶液对创伤休克病人血液流变特性的影响

Effects of 10% HydroxyEthyl Starch on Hemorheology Property and Circulation in Patients with Shock

目的 观察创伤失血性休克病人麻醉手术前快速输入 10 %羟乙基淀粉 (10 %HES 2 0 0 / 0 .5 )溶液后 ,血液流变学及血液循环指标的变化。方法 选择交通事故致创伤失血性休克病人 30例 (失血量 10～ 30ml.kg 1) ,于输液前后分别采取静脉血 3ml,检测血液流变学指标 :低切全血粘度 (30 .S 1)、高切全血粘度 (2 0 0 .S 1)、Hct、血浆粘度、红细胞聚集指数、红细胞变形指数。全程监测平均动脉压、心率、脉搏氧饱和度 (SpO2 ) ,统计术中异体血液制品用量。结果 输注 10 %HES溶液后患者全血粘度明显降低、Hct降低、红细胞聚集指数降低和红细胞变形指数升高等均有显著差异 (P <0 .0 5或P <0 .0 1) ,平均动脉压显著升高及心率明显减慢 (P <0 .0 5或P <0 .0 1) ,术中输异体血量明显少于失血量。结论 输入 15～ 2 0ml.kg 1的 10 %HES溶液能降低低血容量休克病人的全血粘度、Hct和红细胞聚集指数 ,从而优化病人的血液流变状态 ;迅速提高平均动脉压 ,减慢心率 ,改善微循环灌注 ,预防创伤失血性休克并发症 。

Objective To observe the change of Hemorheology and circulation system index in shocked patients rapidly infused with 10% HydroxyEthyl Starch solution before anaesthesia and operation.Methods We studied 30 patients shocked by traffic accidents(blood loss from 15 to 30 ml.kg -1 ).Before and after infusion with HydroxyEthyl Starch solution,venous blood samples were detected for Hemorheology indexes by Hemorheologic detector such as blood,low shear viscosity(30S -1 ),high shear viscosity,hematocrit(Hct),plasma viscosity,index of red blood cell(RBC) aggregation,index of RBC deformation etc.Results High shear viscosity,and low shear viscosity of the patients are decreased obviously(P<0.05),hematocrit,index of RBC aggregation and heart rate of the patients are decreased notably(P<0.01),index of RBC deformation and average artery pressure of the patients rose obviously(P<0.05 or P<0.01).Xenogenic blood product infusion is lower than loss of blood.Conclusions We found that infusion with 10% Hydroxyethyl Starch solution at the dosage from 15 to 30 ml.kg -1 can decrease high shear viscosity,low shear viscosity,hematocrit,plasma viscosity and index of RBC aggregation of the patients shocked by low blood content.It also can improve hemorheologic state of blood,rapidly increase average artery pressure,and slow down heart rate,which improve microcirculation perfusion,prevent complication and improve prognosis of the shocked patients.