不同羟乙基淀粉急性高容量血液稀释对大面积烧伤患者围术期凝血功能的影响

目的 评价羟乙基淀粉130/0.4(HES 130/0.4)与羟乙基淀粉200/0.5(HES 200/0.5)急性高容量血液稀释(AHH)对大面积烧伤患者围术期凝血功能的影响.方法 拟行早期切痂术的大面积烧伤患者40例,年龄18～49岁,ASAⅡ级,随机分为HES 200/0.5组(HES 200组)与HES 130/0.4组(HES 130组),每组20例,另选20名健康志愿者为正常对照组(C组).麻醉诱导开始时HES 200组和HES 130组经30 min分别静脉输注HES 200/0.5、HES 130/0.4 15 ml/kg,行AHH,C组不予任何处理.于麻醉诱导前(T0)、AHH结束即刻(T1)、AHH后1 h(T2)、术后1 h(T3)时采用流式细胞仪检测血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)、CD62P的表达水平,采用血栓弹力图描记仪测定以下指标:反应时间(R).凝血时间(K)、α角、最大振幅(MA)和凝血指数(CI).结果 与C组比较,HES 200组和HES 130组血小板GPⅡb/Ⅲa、CD62P表达上调,R、K缩短,α角、MA、CI增大(P<0.05);与HES 200组比较,HES 130组血小板GPⅡb/Ⅲa、CD62P表达上调,R缩短,α角、MA和CI增大(P<0.05);与T0时比较,HES 200组AHH后血小板GPⅡb/Ⅲa、CD62P表达下调,R、K延长,α角、MA、CI减小(P<0.05),HES 130组R、K延长,α角、CI减小(P<0.05),MA和血小板GPⅡb/Ⅲa、CD62P差异无统计学意义(P>0.05).结论 HES 200/0.5 AHH可抑制大面积烧伤患者围术期血小板过度活化,其减轻血液高凝状态的效应强于HES 130/0.4.

Effect of acute hypervolemic hemodilution with hydroxyethyl starch 200/0.5 or 130/0.4 solution on coagulation function in patients with large-area burn injury during perioperative period

Objective To evaluate the effects of acute hypcrvolemic hemodilution (AHH) with hydroxyethyl starch (HES) 200/0.5 or 130/0.4 on coagulation function in patients with large-area burn injury during perioperative period. Methods Forty ASA Ⅱ patients aged 18-49 yr undergoing early eschar excision surgery were randomly divided into 2 groups (n = 20 each): HES 200/0.5 group (group HES 200) and HES 130/0.4 group (group HES 130). Twenty health volunteers were selected as normal control group (group C). In groups HES 200 and HES 130, HES 15 ml/kg was infused over 30 min at the beginning of induction of anesthesia. Flow cytometry was used to detect the expression of GPⅡb/Ⅲa and CD62P before induction of anesthesia (baseline,T0), immediately after the end of AHH (T1), at 1 h after the end of AHH (T2) and at 1 h after the end of surgery (T3). Thrombelastography (TEG) was used to detect the reaction time (R), clotting time (K), α angle, maximum amplitude (MA) and coagulation index (CI). Results The expression of GPⅡb/Ⅲa and CD62P was up-regulated, R and K were shortened, and α angle, MA and CI were increased in group HES 200 and HES 130 compared with group G (P<0.05). The expression of GPⅡb/Ⅲa and CD62P was up-regulated, R was shortened, and α angle, MA and CI were increased in group HES 130 compared with group HES 200 (P<0.05) . The expression of GPⅡb/Ⅲa and CD62P was down-regulated, R and K were prolonged, and α angle and CI were decreased in group tIES 200 (P<0.05), and R and K were prolonged, and α angle and CI were decreased in group HES 130 as compared to the baseline values at T0(P<0.05). Conclusion AHH with HES 200/0.5 can alleviate hypercoagulable state through inhibitting excessive platelet activation during perioperative period in patients with large-area burn and HES 200/0.5 is better than HES 130/0.4.