不同分子量和取代级的羟乙基淀粉溶液对兔凝血功能的影响

Effects of hydroxyethyl starch of different molecular weight and degree of substitution on blood coagulation in rabbits

目的观察家兔输注羟乙基淀粉(贺斯,HES)HES 450/0.7、HES 200/0.62、HES 200/0.5和HES130/0.4后的凝血功能变化。方法 家兔40只,随机分为5组(n=8):组I:HES 450/0.7;组Ⅱ:HES200/0.62;组Ⅲ:HES 200/0.5;组Ⅳ:HES 130/0.4;组Ⅴ:0.9％NaCl。按10 ml·kg-1·h-1输注胶体,共3 h,于输注前、输注1 h、2 h、3 h测定凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIb)及血栓弹性描记图TEG(R、K、α角及MA)。结果 (1)输注30 ml·kg-1后,组I:R(16.1±1.9)min、K(6.0±2.1)min,α(35±9)deg,MA(45±5)mm(P<0.01);组Ⅱ:R(15.4±1.0)min,K(7.0±2.1)min,α(34±5)deg,MA(38±9)mm(P<0.01)。(2)输注20 m1·kg-1后五组PT均延长(P<0.05)。(3)组I、组Ⅱ输注30ml·kg-1后APTT显著延长(P<0.05)。(4)组I输注30ml·kg-1后FIb显著降低(P<0.05)。结论HES 450/0.7与HES 200/0.62大剂量输注对凝血功能有显著影响,HES 200/0.5与HES 130/0.4则无明显损害。

Objective To assess the changes in blood coagulation after infusion of hydroxyethyl starch 45/ 0.7(molecular weight = 450000 Dalton, 70% of glucose units have been substituted) ,200/0.62, 200/0.5 and 130/0.4.Methods Forty rabbits weighing (2.6 ±0.5)kg were randomly divided into 5 groups of 8 animals each: group I HES450/0.7; group II HES 200/0.62; group III HES200/0.5; group IV HES 130/0.4; group V 0.9% NaCl. The animals were anesthetized with intramuscular seconal and ketamine. Hydroxyethyl starch or normal saline was infused at 10 ml·kg-1·h-1 for 3 h. Blood samples were taken before and 1,2,3 h after staring the infusion for determination of prothrombin time ( PT), activated partial thromboplastin time (APTT) and fibrinogen level (FIb) and thromboelastograph examination (TEG) .Results (1) After infusion of 30 ml·kg-1 HES 450/0.7 or 200/0.62 (in group I and II ) R time (representing the rate of initial fibrin formation) and K time (coagulation time) were significantly prolonged (P<0.01);α angle and MA (maximal amplitude indicating qualitative platelet function and percent fibrinolysis) were significantly decreased (P < 0.01) . (2) PT was significantly prolonged after infusion of 20 ml· kg-1 in all 5 groups ( P < 0.05) . (3) APTT was significantly prolonged after 30 ml·kg-1 was infused in group I and II(P<0.05). (4) Fibrinogen level was significantly decreased after 30 ml· kg-1 was infused in group I ( P < 0.05) . Conclusions HES 450/0.7 and 200/0.62 have significant effect on blood coagulation after a certain amount is infused, while HES 200/0.5 and 130/0.4 do not.