羟乙基淀粉200/0.5和羟乙基淀粉130/0.4术前急性高容量血液稀释对结肠癌根治术患者血液流变学的影响

目的 评价6%羟乙基淀粉(HES)200/0.5和6%HES 130/0.4术前急性高容量血液稀释(AHH)对结肠癌根治术患者血液流变学的影响.方法 择期在全麻下行结肠癌根治术患者40例,ASA Ⅰ或Ⅱ级,随机分为2组(n=20),麻醉诱导期间于30 min内静脉输注15 ml/kg HES 200/0.5(Ⅰ组)或HES 130/0.4(Ⅱ组),AHH结束后开始手术.分别于麻醉诱导前(基础状态,T0)、AHH后即刻(T1)、AHH结束后1 h(T2)和术后1 h(T3)时抽取静脉血样,检测全血粘度、血浆粘度、红细胞聚集指数、血小板聚集指数和红细胞压积(Hct).结果 与T0时比较,Ⅰ组T1时全血低切粘度和红细胞聚集指数降低,T1-3时全血中切粘度、全血高切粘度、血浆粘度、血小板聚集指数和Hct降低,Ⅱ组T1-3时全血低切粘度、全血中切粘度、全血高切粘度、血浆粘度、红细胞聚集指数和Hct降低(P<0.05);与Ⅰ组比较,Ⅱ组T2,3时全血低切粘度和红细胞聚集指数降低,T1-3时血小板聚集指数升高(P<0.05).结论 6%HES 200/0.5与6%HES 130/0.4(15 ml/kg)术前AHH均能改善结肠癌根治术患者围术期血液流变学,其中6% HES 130/0.4的效果较好.

Effects of acute hypervolemic hemodilution with 6% hydroxyethyl starch 200/0.5 or 130/0.4 before operation on hemorheology in patients undergoing radical operation for colon tumor

Objective To evaluate the effects of acute hypervolemic hemodilution(AHHD)with 6% hydroxyethyl starch(HES)200/0.5 or 130/0.4 before surgery on hemorheology in patients undergoing radical operation for colon tumor.Methods Forty ASA Ⅰ or Ⅱ patients aged 46-64 yr,weighing 47-61 kg undergoing radical surgery for colon tumor were randomly divided into 2 groups(n=20 each):group Ⅰ 6%HES 200/0.5and group Ⅱ 6% HES 130/0.4.In both groups HES 15 ml/kg was infused over 30 min before surgery.Blood samples were taken before AHHD(baseline,T0),at the end of AHHD(T1)and 1 h after the end of AHHD(T2) and 1 h after the end of surgery(T3)for determination of blood viscosity,plasma viscosity,erythrocyte aggregation index,platelet aggregation index and Hct.Results In group Ⅰ the blood viscosity at middle and high shear rate,plasma viscosity,platelet agdgregation index and Het were signjfieantly decreased at T1-3 as compared to the baseline values at T0.In group Ⅱ the blood viscosity,plasma viscosity,erythrocyte aggregation index and Hot were significantly decreased at T1-3 as compared to the baseline values at T0.The blood viscosity at low shear rate and erythroeyte aggregation index were significantly higher at T2,3 while the platelet aggregation index was significantly lower at T1-3 in group Ⅰ than in groupⅡ.Conclusion Both AHHD with 6%HES 200/0.5 and 130/0.4 can improve hemorbeology in patients undergoing radical operation for colon Unnor and 6% HES 130/0.4 is better than 6% HES 200/O.5.