6%中分子量羟乙基淀粉用于术前急性高容血液稀释对凝血功能的影响

EFFECT OF PREOPERATIVE ACUTE HYPERVOLEMIC HEMODILUTION WITH 6% MEDIUM MOLECULAR HYDROXYETHL STARTCH ON THE ACTIVITY OF COAGULATION

目的 :观察 6 %羟乙基淀粉 (贺斯 ,HES 2 0 0 / 0 .5 )为容量扩充剂行术前急性高容血液稀释 (AHHD)对凝血功能的影响。方法 :5 0例择期手术 ,术前无凝血功能障碍 ,在全麻或硬膜外阻滞后以病人全血容量的 2 0 % (2 0～ 2 5 ml/ kg)输入 6 %贺斯 ,速度为 2 0～ 2 5 m l/ kg· h- 1。于输液前及输入 6 %贺斯后 30 ,6 0 min采集静脉血样测定血红蛋白 (Hb)、红细胞比容 (Hct)、血小板计数 (PL C) ,凝血酶原时间 (PT) ,凝血酶原时间国际比率 (INR)、部分凝血活酶时间 (APTT)、凝血酶时间 (TT)、纤维蛋白原(FIB)。结果 :输入 6 %贺斯后 Hb从 (131.88± 10 .4 5 ) g/ L 降至 (90 .99± 10 .10 ) g/ L,Hct从 0 .4 1± 0 .0 3降至 0 .32± 0 .0 2 ,差异有统计学意义 (P <0 .0 1) ,达轻度血液稀释。输入 6 %贺斯后 PL C、FIB均降低 ,但差异无统计学意义 (P >0 .0 5 )。PT、INR、APTT、TT无明显改变。结论 :选用 6 %贺斯为容量扩充剂 ,以约 2 0～ 2 5 ml· kg- 1静脉输注 。

Obictive:To evaluate the influences of preoperative acute hypervolemic hemodilution (AHHD) with 6% medium molecular Hydroxyethl startch(HES 200/0.5) on the activity of coagulation. Methods:Fifty adult patients without abnormal coagulation, scheduled for elective surgery, were inchuded in the study. Under general or epidural anestheesia they received intravenous infusion of HES(20~25 ml/kg) at a rate of 20~25 ml/kg·h -1 . The infused volume of HES approximated 20% of the patients' estimated total blood volume. AHHD was completed before the start of surgery. The venous blood samples were taken before, 30 and 60 min following the infusion, to determine platelet(PLC), prothrombin time(PT), thrombin time(TT), international normalized ratio(INR), activated partial thromboplastin time(APTT). Results:After the infusion of HES, haemoglobin concentration decreased significantly from 0.41±0.03 to 0.32±0.02. PLC, PT, INR, APTT, TT as well as FIB did not differ statistically at all times. Conclusions:Slight acute hypervolemic hemodilution with 6% HES 20~25 ml·kg -1 does not affect the activity of blood coagulation.