摘要
目的评价不同人工胶体液进行急性高容量血液稀释（AHH）时对凝血功能的影响。方法20例ASAⅠ～Ⅱ级择期手术的良性疾病患者，随机均分为6％羟乙基淀粉组（HES组）和4％琥珀酰明胶组（MFG组）。全麻后输入HES（200／0．5）或MFG，20ml／kg，（25±5）min内输完。分别于AHH前后，由静脉取血检测血常规、凝血酶原时间（PT）、部分激活凝血活酶时间（APTT）、Ⅷ因子活动度（Ⅷ：C）、血管性血友病因子（vWF）、纤维蛋白原（FIB）、血小板膜糖蛋白（GpⅡb／Ⅲa）和血栓弹力描记图（TEG）。同时监测HR、MAP和CVP。结果（1）两组患者AHH后的Hct都降低至30％左右，达到中度血液稀释。（2）两组患者AHH前后血流动力学稳定。（3）与AHH前相比，AHH后两组患者PT、APTT均明显延长，HES组的Ⅷ：C明显下降；两组患者vWF和FIB均明显下降；GPⅡb／Ⅲa无明显变化；两组患者TEG均有凝m功能受损的表现。结论HES和MFG对vWF和（或）Ⅷ因子有抑制作用，APTT的明显延长和TEG的凝血功能受损可能与这一抑制作用有关。AHH后除APTT外各凝血参数均在正常范围内。
Objective To compare the effect of 6% hydroxyethyl starch （HES 200/0.5） with that of 4% MFGatin on haemostasis during acute hypervolemie haemodilution （AHH）. Methods Twenty patients with benign diseases were randomly divided into two groups. In group Ⅰ , HES 20 ml/kg was infused, and in group Ⅱ 4% MFGatin 20 ml/kg. Blood samples were taken from veins before anesthesia （T1）, before AHH after anesthesia completed （T2）, at 10 rain after AHH comple- ted （T3） and 30 min after AHH completed （T4）. The hemoglobin（Hb）, hematocrit （Het）, blood platelet count （Plt）, prothrombin time （PT）, activated partial thromboplastin time（APTT）, factor ：C, yon Willebrand factor （vWF）, fibrinogen （FIB）, glycoprotein Ⅱ b/Ⅲ a（Gp Ⅱ b/Ⅲ a） and thromhoelastograpm （TEG） were measured. Heart rate （HR）, mean arterial pressure （MAP） and central venous pressure （CVP） were also recorded. Results After AHH, HR, MAP and CVP remained normal in both groups, and no significant difference was found in GP Ⅱ b/Ⅲ a. In both groups the following changes were found after AHH： prolonged PT and APTT, decreased FIB, MA and vWF （P〈0.05）. There was a significant decrease in factor Ⅶ：C in HES group （P〈 0. 05）. Conclusion In our study, moderate hemodilution was acquired with the stable hemodynamic state. Both HES 200/0.5 and 4% MFGatin inhibited vWF and （or） factor Ⅶ ：C. This inhibition may result in the prolongation of APTT and in the changes in TEG. All indexes of hemostasis was in the normal range after AHH except APTT.
出处
《临床麻醉学杂志》
CAS
CSCD
2007年第1期6-8,共3页
Journal of Clinical Anesthesiology
