应用6%羟乙基淀粉130/0.4行急性扩容性血液稀释对脑肿瘤切除术患儿凝血功能和血流动力学的影响

Effect of acute hypervolemic hemodilution with 6% hydroxyethyl starch 130/0.4 on coagulation and hemodynamics in paediatric patients undergoing brain tumor surgery

目的研究应用6%羟乙基淀粉(HES)130/0.4行急性扩容性血液稀释(AHH)对脑肿瘤切除术患儿凝血功能和血流动力学的影响。方法选取择期在全身麻醉下行脑肿瘤切除术的患儿40例,随机分入6%HES130/0.4组(HES组)和乳酸钠林格注射液组(LR组),每组20例,分别输注6%HES130/0.4或乳酸钠林格注射液15mL/kg进行血液稀释。在预扩容前(T0),预扩容后10min(T_1)、1h(T_2),以及手术结束(T_3)时抽取静脉血,测量血栓弹力图(TEG)的各参数,并记录各时间点血流动力学指标的变化。结果 HES组T_1、T_2时间点和LR组T_1时间点的血红蛋白水平和红细胞比容均显著低于同组T_0时间点(P值均<0.05),两组T_1时间点的中心静脉压均显著高于同组T0时间点(P值均<0.05),HES组T_1时间点的中心静脉压显著高于LR组同时间点(P<0.05)。两组组内和组间不同时间点的心率和平均动脉压的差异均无统计学意义(P值均>0.05)。HES组T_1、T_2时间点的血栓最大幅度均显著小于同组T_0时间点和LR组同时间点(P值均<0.05),两组组内和组间其余TEG参数的差异均无统计学意义(P值均>0.05)。结论15 mL/kg 6%HES130/0.4可安全用于脑肿瘤患儿术中的扩容治疗,能维持患儿血流动力学和凝血功能的稳定。

Objective To explore the effect of acute hypervolemic hemodilution （AHH） with 6% hydroxyethyl starch 130/0. 4 on hemodynamic and coagulation in paediatric patients undergoing brain tumor surgery. Methods Forty paediatric patients prepared for elective brain tumor surgery under general anesthesia were randomly divided into 6% hydroxyethyl starch （HES） 130/0.4 group and sodium lactate Ringer＇s solution （LR） group. There were 20 cases in each group. HES and sodium lactate ringer-s solution （15 mL/kg） were infused for AHH in two groups, respectively. Venous blood was drawn for thromboelastography （TEG） measurement before AHH （T0）, 10 min after AHH （T1）, 1 h after AHH （T2）, and at the end of surgery （T3）. Hemodynamic parameters were recorded at each time point. Results The hemoglobin （Hb） and hematokrit （HOT） at T1 and T2 were significantly lower than those at T0 in the HES group （all P.〈0.05）, Hb and HCT at T1 were significantly lower than those at To in the LR group （both P〈0.05）. Central venous pressure （CVP） at T1 were significantly higher than those at To in both groups （both P ,〈 0. 05）, and CVP in the HES group was significantly higher than that in the LR group at T1 （P〈0.05）. No significant differences were found in the heart rate （HR） or mean arterial pressure （MAP） between groups or at different time points in each group （all P〉 0.05）. The maximal amplitude （MA） of thrombus at T1 and T2 in the HES group were significantly smaller compared with that at To and those at T1 and T2 in the LR group （all P〈0.05）. Conclusion AHH with 15 mL/kg 6 % HES130/0.4 can maintain stable hemodynamics and blood coagulation function and be safely used in pediatrics undergoing brain tumor resection. （Shanghai Med J, 2016, 39： 72-75）