6%羟乙基淀粉急性高容血液稀释对围术期肺癌患者凝血功能的影响

目的 用6％羟乙基淀粉（hydroxyethyl starch，HES）溶液行急性高容血液稀释（acute hypervolemic hemodilution，AHHD），观察其对肺癌患者围手术期凝血功能的影响。方法择期行肺癌根治术患者40例，随机分为2个组：6％羟乙基淀粉（HES）组和对照组（每组20例）。HES组麻醉前快速输注6％HES（15ml／kg，于30min内），术中的失血量用等量的HES溶液补充，其余的液体需要量用乳酸钠林格氏液（RL）补充。对照组仅输注RL，不实施AHHD。检测输注液体前（T1）、手术开始后5min（T2）、术毕30min（T3）、术后6h（T4）时的血栓弹力图参数反应时间（R）、凝血时间（K）、α角（ANG）、最大振幅（MA）以及凝血酶原时间（PT）、激活的部分凝血活酶时间（APTT）、凝血酶时间（TT）、血小板数目（PLT）。结果HES组：T2、T3、T4时的ANG、MA均低小于对照组；T2、T3、T4时的凝血时间、PT、APTT、TT均长于对照组（P〈0．05或P〈0、01）；T2、T3、T4时的PLT均低于对照组（P〈0．05或P〈0、01）。HES组T3、T4时的各项凝血指标与T1时比较无明显差异（P〉0.05）；对照组：T3、T4时的ANG、MA均大于T1时；凝血时间、PT、APTT、TT均短于T1（P〈0．05或P〈0．01）。2组的失血量比较无统计学差异。结论 用6％HES行AHHD对围术期肺癌患者能产生一定的抗凝效果，这对本来就存在凝血功能亢进的肿瘤患者的预后及康复有积极意义。

Effect of Acute Hypervolemic Hemodilution with 6% Hydroxyethyl Starch on Coagulation of Patients with Lung Cancer During Perioperative Period

Objective To observe the effect of preoperative acute hypervolemic hemodilution(AHHD) with 6% Hydroxyethyl Starch(HES) on coagulation of patients with lung cancer during periopartive period.Methods 40 patients with lung cancer were randomly divived into HES group(n=20) and control group(n=20) before radical operation.In HES group,6% HES solution was infused at a dose of 15 ml/kg within 30 min before anesthesia.Then the patients received HES solution equal to the intraoperative blood loss and lactated Ringer's solution.In control group,only lactated Ringer's solution was infused without AHHD.Thrombelastography variables(R,K,ANG,MA) and PT,APTT,TT,platelet count were measured before fluid infusion(T_1),5min after operation beginning(T_1),30 min after operation(T_3) and 6 h after operation(T_4).Results Compared with control group,ANG and MA decreased at T_2,T_3 and T_4(P<0.05 or P<0.01);K,PT,APTT and TT were lengthened at T_2,T_3 and T_4(P<0.05 or P<0.01);Platelet count at T_2,T_3 and T_4 reduced(P<0.05 or P<0.01) in HES group.There was no significant difference in coagulation markers between T_1 and T_3,T_4 in HES group(P>0.05),but ANG and MA at T_3 and T_4 were larger than those at T_1 in control group(P<0.05 or P<0.01).K,PT,APTT and TT at T_3 and T_4 were shorter than those at T_1(P<0.05 or P<0.01).There was no marked difference between the two groups in blood loss(P>0.05).Conclusion Patients with cancer have an over coagulation tendency.AHHD with 6%HES can produce anticoagulation effect on lung cancer patients,which is benefit to their prognosis and rehabilitation.