琥珀酰明胶对体外循环血液流变学影响的临床观察

Clinical Observation on the Effect of Gelofusine on Hemorheology of Cardiopulmonary Bypass

目的 观察琥珀酰明胶（Gelofusine）应用于体外循环（cardiopulmonary bypass,CPB）对血液流变学的影响.方法 24例儿童房室缺患者,其中男10例,女14例,年龄8～ 14岁,体重21 ～ 34kg,随机分为琥珀酰明胶（G）组（n=12）,乳酸钠林格液组（RL）组（n=12）,2组分别用琥珀酰明胶和乳酸钠林格30～ 50mL/kg预充体外循环管路,其余方法均相同.在CPB开始前,CPB开始后20 min和CPB结束时由中心静脉抽血行血流变学测.结果 CPB开始后20 min和CPB结束时G组（低、中、高切变率）全血粘度、红细胞压积（HCT）、纤维蛋白原较（FIB） CPB前明显下降（P＜0.01）,血沉（ESR P＜0.01）、红细胞聚集指数和升高,血浆粘度无明显变化;RL组CPB开始后20 min和CPB结束时血沉、红细胞聚集指数无明显变化,其余各项指标均明显下降（P＜0.01）;2组之间CPB开始后20 min和CPB结束时,G组CPB开始后20 min和CPB结束时高切变率全血粘度（P＜0.01）、血浆粘度（P＜0.01）、ESR （P＜0.01）、红细胞聚集指数（P＜0.05）,均高于RL组.结论 体外循环中应用琥珀酰明胶使红细胞变形性降低、聚集性升高,增加血细胞破坏,有可能使微循环灌注不足.

Objective To observe the effect of Gelofusine on the hemorheology of cardiopulmonary bypass （CPB） Methods 24 pediatric patients with atrial septal defect and ventricle septal defect were performed CPB,which included 10 males and 14 females with 8-14 years old of age and 21-34 Kg of weight,and were divided into two groups：Sodium Lactate Ringer＇s Injection （RL） group （n=12） or Gelofusine group （n=12）.Patients in the two groups were given Sodium Lactate Ringer＇s （n=12） Injection （RL） or Gelofusine （G） （n=12） priming 30-50 mL/kg,respectively.Blood samples were collected from central vein before CPB,20 minutes after the onset of CPB and at the end of CPB.The hemorheological indexes were tested.Restults 20 minutes after the onset of CPB and at the end of CPB,the blood viscosity （low,middle and high shear rate）,hematocrit （HCT）,fibrinogen （FIB） were lower than before CPB in all patients （P＜0.01）.While plasma viscosity did not change （P＞0.05）,Erythrocyte sedimentation rate （ESR）,red cell assembling index was higher than before CPB （P＜ 0.05） in the G group.20 minutes after the onset of CPB and at the end of CPB plasma viscosity was lower than before CPB （P＜0.01）,ESR and red cell assembling index did not change in the RL group （P＞0.05） 20 minutes after the onset of CPB and at the end of CPB,the high shear rate blood viscosity （P＜0.01）,ESR （P＜0.01）,red cell assembling index of G group were higher than RL group.Conclusion The application of Gelofusine in CPB may reduce red cell assembling,promote red blood cell deformability and obstruct microcirculation.