摘要
为对比观察不同剂量的葡萄糖酸钙对佳乐施扩容性血液稀释性凝血功能抑制的预防作用 ,将 30例颅脑手术病人分为 3组 ,Ⅰ组单独用佳乐施 ,Ⅱ组、Ⅲ组佳乐施中葡萄酸钙的加入量分别为 1g/L和 2 g/L。麻醉诱导后 ,分别用相应液体以 2 5mL/min的速度扩容 ,分别于麻醉诱导后、输液 5 0 0、1 0 0 0、1 5 0 0mL及完成扩容后 30min时测定红细胞比容 (HCT)、活化部分凝血活酶时间 (APTT)、血浆凝血酶原时间 (PT)、血清钙离子浓度 (Ca2 + )等参数。结果 :3组病人扩容期间PT和APTT均逐渐延长 ,但Ⅱ组和Ⅲ组病人延长程度明显低于Ⅰ组 ,而Ⅱ组和Ⅲ组病人之间基本相同。输入 1 5 0 0mL后 ,Ⅰ组病人PT和APTT分别延长 1 3.9%和 2 1 .8% ,Ⅱ组分别延长 1 0 .6 %和 1 2 .4 % ,Ⅲ组分别延长 9.8%和 8.2 %扩容期间。Ⅰ组病人血清Ca2 + 逐渐降低 ,Ⅱ组无明显变化 ,Ⅲ组明显增高 ,输入 1 5 0 0mL后 ,Ⅰ组病人Ca2 + 降低 1 3.8% ,Ⅱ组无明显变化 ,Ⅲ组增高 6 .4 %。提示佳乐施可较好地应用于扩容性血液稀释 ,但可造成凝血功能下降 ,Ca2 + 较低是其主要原因之一 ,输入 5 0 0mL佳乐施的同时补充 0 .5 g葡萄糖酸钙可起到一定的预防作用。
To compare the changes of coagulation during hypervolemic hemodilution induced by gelofusine (G) or gelofusine containing calcium gluconate (calglucon), 30 neurosurgical patients without heart diseases were randomly allocated into three groups. Hypervolemic hemodilution was induced by rapid infusion, 25 mL/min, of gelofusine (groupⅠ, n=10), gelofusine containing calglucon (0.5 g in 500 mL, groupⅡ, n=10) and of gelofusine containing calglucon (1.0 g in 500 mL, groupⅢ, n=10) after general anesthesia. Hematocrit (HCT), activate partial thromboplastin time (APTT), prothrombin time (PT) and calcium concentration in serum (Ca 2+ ) were tested after anesthesia induction, gelofusine infusion of 500 mL, 1 000 mL, 1 500 mL and 30 min after infusion, respectively. During hypervolemic hemodilution, PT and APTT were prolonged more in groupⅠthan in groupⅡ and groupⅢ. In groupⅠ, PT and APTT were prolonged by 13.9% and 21.8%, respectively. PT and APTT were prolonged by 10.6% and 12.4% , respectively in groupⅡ, and were prolonged 9.8% and 8.2%, respectively in groupⅢ. Ca 2+ decreased by 13.8% in groupⅠ, but it did not change significantly in groupⅡ, and increased by 6.4% in groupⅢ, after infusion of 1 500 mL gelofusine. The result shows that gelofusine is suitable for hypervolemic hemodilution, but it leads to coagulation disorder which is related to the decreased serum Ca 2+ . Adding 0.5 g calglucon to 500 mL of gelofusine can partly prevent the depression of coagulation.
出处
《首都医科大学学报》
CAS
2002年第2期131-134,共4页
Journal of Capital Medical University
基金
北京市卫生局临床麻醉研究基金项目 (卫科扶字 0 6号 )
