围术期输注羟乙基淀粉对凝血-纤溶动态平衡的影响

目的：考察贺斯在围术期对凝血-纤溶系统的影响。方法：选择ASAⅠ～Ⅱ级的择期手术患者34例随机分为两组。经静脉分别输注贺斯1000ml或乳酸林格氏液（以下简称平衡液）1000ml，速度为25ml／Kg／h，然后用乳酸林格氏液500ml／h维持。测定病人的凝血酶活性（F．Ⅱa）、纤溶酶原活性（Pig）。采用凝血-纤溶动态图仪测定其曲线的上升斜率（简称上斜）、下降斜率（简称下斜）及参数凝同启动时间（CST）、最大凝固时间（MCT）、完全纤溶时间（WFT）、平衡时间（BLT）、最大凝固程度（MCE）。结果：纤溶酶原活性、凝血酶活性分别在输注完即刻或输注完2h表现为逐渐下降，但同组不同时点的比较无差异显著性（P〉0．05），两组间同时点的比较亦无差异显著性（P〉0．05）。两组病人围术期凝血-纤溶动态平衡各参数输注前与输注后各时点比较均无差异显著性（P〉0．05）。结论：围术期快速输注贺斯1000ml，在扩容的同时，对凝血-纤溶系统的影响轻微，无过敏样反应发生，在围术斯可以安全的应用。

Influence of HES on coagulation-fibrinolysis system during perioperative stage

Objective: To observe the influence of HES on coagulation-fibrinolysis system during perioperative stage.Methods: 34 I~II grade ASA patients were randomly selected and divided into two groups.Group A(n=18) was transfused 1000ml HES,group B(n=16) transfused with 1000ml of equilibrium liquid 1000ml,both at the rate of 25ml/Kg /h,then both transfused with equilibrium liquid at the rate of 500ml/hr.coagulation-fibrinolysis parameters of coagulation starting time(CST),maximum coagulation time(MCT),the whole time of fibrinolysis reaction(WFT),the balance time(BLT),maximum extent of coagulation(MCE) were measured by dynamicgraphy instrument(CFD-III).Blood plasma thrombin,F.IIa and Plasminogen,Plg were measured at the preoperation,the end of transfuse of 1000ml of liquor instantly and 2 hr later,respectively.Results: F.IIa and Plg in two groups decreased,but no significant difference was found a many different time paints in the serve group(P>0.05) The companrison at the same time paint showed no significant difference between two groups(P>0.05).Conclusion : Transfuse of 1000ml HES at perioperative stage could proliferate blood volume,and have mild influence on coagulation-fibrinolysis system without anaphylactoid reaction.It could be safely used at perioperative stage.