Thrombelastographic coagulation analysis following in vitro and in vivo haemodilution with hydroxyethyl starch (HES)

In the study presented the effects of in vitro hemodilution with HES on coagulation are compared with the effects of in vivo hemodilution using thrombelastography (TEG). The in vivo hemodilution was performed by the i. v. infusion of 1000 ml 6 % solution of hydroxyethyl starch HES (2 formulations with HES 130/0.4 and one formulation with HES 200/0.5) in healthy volunteers during 30 min. The in vitro hemodilution was performed with blood samples taken from the volunteers before the infusion was started. These samples were diluted with HES-solution until the same hemoglobin concentration measured at the end of the infusion was attained. The in vivo TEG-parameters remained in the reference range of the method, however all in vitro TEG-parameters are out of the range of normal values. The isolated interpretation of the in vitro data shows an impairment of blood coagulation. The shortening of the reaction time as an indicator for the initiation of blood clotting points to activated coagulation by in vivo hemodilution with HES, whereas in vitro the prolongation of the reaction time is indicative for retardation of clotting. The evaluation of the TEG-parameters and of other clotting parameters determined prior to the beginning of the infusion, at the end of the infusion and four hours after termination of the infusion of HES 130/0.4 and of HES 200/0.5 to healthy volunteers show alterations of blood coagulation parameters caused mainly by dilutional effects. The more pronounced alterations found in vitro cannot be interpreted as impairment of haemostasis in vivo. On the other hand, the likewise haemodilution in vitro causes an impairment of coagulation. Therefore, the effects of in vitro hemodilution with HES on coagulation differ qualitatively and quantitatively from the effects of in vivo hemodilution.     

6%羟乙基淀粉200/0.5的药代动力学研究

目的 研究择期手术中单次静脉输注6%羟乙基淀粉200/0.5(HES 200/0.5)的药代动力学.方法 选择10例接受择期手术的患者,ASA Ⅰ级,在15 min内静脉输入10 ml/kg的HES200/0.5,应用蒽酮比色方法测定输注后相应时点血清中HES 200/0.5的浓度,并采用3P97软件计算其药代动力学参数.选择二室模型权重为1时计算药代动力学参数最符合HES 200/0.5的体内特点.结果 所测药代动力学参数如下:t1/2α=3.25 h,t1/2β=163.9 h,K10=0.0877,K12=0.1195,K21=0.0102,Vd=2.164,Cl(s)=0.18985,AUC=52.67 mg·h-1·ml-1.结论 术中单次静脉输注10 ml/kg HES 200/0.5后,血药浓度一时间曲线符合二室模型,血管内停留时间充足,分布半衰期较长.     

Plasma substitution effects of a new hydroxyethyl starch HES 130/0.4 compared with HES 200/0.5 during and after extended acute normovolaemic haemodilution

Background. The volume expansion effect of a recently introducedhydroxyethyl starch, HES 130/0.4, was compared with the commonlyused HES 200/0.5 after rapid infusion of a single large dose(up to 2 litres) administered during acute normovolaemic haemodilution(ANH). Methods. This prospective, randomized, double-blind study included40 patients scheduled for major abdominal surgery with no contraindicationto ANH. Patients were randomized to undergo ANH with eitherHES 130/0.4 (n=20) or HES 200/0.5 (n=20). Blood was collectedto reach a target haemoglobin level of about 8.0 g dl^–1and simultaneously replaced by the same volume of colloid (HES130: 1825 [SD 245] ml; HES 200: 1925 [183] ml). Heart rate,mean arterial pressure, cardiac filling pressure, and cardiacoutput were measured before induction of anaesthesia (baseline),10 min after completion of ANH, before surgery, at the end ofsurgery and on the following morning (postoperative day 1; POD1).ANH blood was systematically retransfused during surgery orbefore POD1. Results. Exchange of about 40% of blood volume resulted in similarhaemodynamic changes in both groups. Filling pressures increasedsignificantly, while cardiac index remained unchanged (HES 130:from 3.3 [0.4] to 3.2 [0.7] litre min^–1 m^–2; HES200: from 3.0 [0.6] to 3.1 [0.7] litre min^–1 m^–2).Need for crystalloids and colloids was similar between the groupsduring surgery and on POD1. Total blood loss (HES 130: median2165 ml, range 660–2970 ml; HES 200: median 2464 ml, range640–19 380 ml) and amount of allogeneic red blood cellstransfused (HES 130: median 0, range 0–4 units; HES 200:median 0, range 0–18 units) were comparable in the twogroups. Conclusions. This study demonstrates a good immediate and medium-termplasma volume substitution effect of HES 130 compared with HES200. HES 130 could represent a suitable synthetic colloid forplasma volume substitution during extensive ANH. Br J Anaesth 2003; 91: 196–202     

In vivo effect of haemodilution with saline on coagulation: a randomized controlled trial

Background. Previous studies have shown that 10–30% haemodilutionwith crystalloid may induce a hypercoagulable state demonstrableby using the Thrombelastograph^® (TEG). While most are invitro studies, the few in vivo studies are limited by confoundingsurgical or ‘environmental’ factors. We conductedthis randomized controlled study to evaluate the coagulationchanges associated with in vivo haemodilution. Methods. Twenty patients undergoing major hepatobiliary surgerywere randomly allocated to one of two study groups. Group H(n=10) had 30% blood volume withdrawn over 30 min and replacedwith saline. Group C (n=10) did not have any blood withdrawn.Blood samples were taken in both groups at 10, 20 and 30 min.Native TEG, complete blood count, coagulation profile, fibrinogen,antithrombin III, protein C and thrombin–antithrombincomplex concentrations were measured. Results. Compared with Group C, Group H patients had significantlygreater shortening of r-time at 30 min (–30% vs +36%),greater shortening of k-time at all time points (–36%vs +17% at 10 min; –37% vs +44% at 20 min; –45%vs +49% at 30 min), and greater widening of     

Effect of progressive haemodilution with hydroxyethyl starch, gelatin and albumin on blood coagulation

We have compared the effects of progressive (30% and 60%) in vitro haemodilution with hydroxyethyl starch (HES), gelatin (GEL) and albumin (ALB) with haemodilution using 0.9% saline in 96 patients by thrombelastography. Haemodilution with HES, GEL and ALB significantly (P < 0.05) compromised coagulation time (k), angle alpha and maximal amplitude (MA), with HES having the most negative effect at 30% and 60% haemodilution (P < 0.05). Haemodilution with saline significantly affected all variables of blood coagulation and clot lysis measured by thrombelastography, resulting in an increased coagulability at 30% haemodilution. To specifically assess the intrinsic effect of plasma expander molecules on blood coagulation and clot lysis, we analysed the difference between saline diluted blood (same degree of haemodilution) and plasma expander diluted blood. Prolongation of reaction time (r) was found for HES at 30% and 60% haemodilution and for ALB at 60% haemodilution and an increase in clot lysis by HES, GEL and ALB became evident. We conclude that HES, GEL and ALB compromised blood coagulation, while the maximum effect was found with HES.      

6%羟乙基淀粉200/0.5氯化钠注射液对外科手术围术期凝血功能和肾功能的影响

目的 探讨围手术期应用6%羟乙基淀粉(Hetastarch,HES)200/0.5氯化钠注射液对外科手术中全麻患者凝血功能及肾功能的影响.方法 限期全麻胃肠道恶性肿瘤手术患者40例,随机分为两组,每组20例:6%HES 130/0.4(A组,万汶)和6%HES200/0.5(B组,代斯).根据晶胶结合(2∶1)的原则补液,全麻术中输实验药物1000ml,术后第1、2天输实验药物量为1000ml/d.术前和术后第3天检测以下指标:血红蛋白(Hb)、血细胞比容(Hct)、血尿素氮(BUN)、血清肌酐(SCr)、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)、von Willebrand(vWF)因子活性、Ⅷ因子活性、全血黏度高切变率、全血黏度低切变率、血浆黏度.结果 术后两组患者Hb、Hct均下降,但组间差异无统计学意义(P>0.05).术后两组患者SCr均明显下降,组间、组内差异均有统计学意义(P<0.05),但均在正常范围.两组患者PT、TT、APTT、全血黏度高切变率、血浆黏度、vWF因子活性、Ⅷ因子活性、BUN术前术后改变组间、组内差异无统计学意义(P>0.05).结论 6%羟乙基淀粉200/0.5氯化钠注射液进行容量替代治疗时对外科手术全麻患者凝血功能及肾功能的影响较小.     

6%羟乙基淀粉(200/0.5)氯化钠注射液术中应用的安全性研究

人工胶体作为血容量扩充药,在低血容量、休克的治疗及预防中发挥极为重要的作用。以玉米淀粉为原料的羟乙基淀粉溶液(德国费森尤斯公司研制,商品名:贺斯(HES))是继明胶和右旋糖酐类胶体之后的第三代人工胶体。1999年国内开始同类产品的开发,目前已研制成功6%羟乙基淀粉(200/0.5     

Renal effects of hypotensive anaesthesia in combination with acute normovolaemic haemodilution with hydroxyethyl starch 130/0.4 or isotonic saline

BACKGROUND: Hypotensive anaesthesia (HA) and acute normovolaemic haemodilution (ANH) are used separately to decrease per-operative blood loss. Reducing blood viscosity by adding ANH to HA may appear profitable in a situation with lowered perfusion pressure and concern about organ ischemia. The aim of this study was to clarify the influence of HA in combination with ANH using crystalloid or colloid as replacement fluid on renal function. METHODS: Hypotensive anaesthesia was induced in 11 patients referred to major spine surgery using sevoflurane in combination with fentanyl/remifentanil. Acute normovolaemic haemodilution was carried out by drawing venous blood into standard blood bags and replacing it by isotonic saline 0.9% (Group S) or HES 130/0.4 (Group V). Renal function was evaluated before, during and up to 8 h after hypotension as the glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) by means of 51Cr-EDTA and 125I-Hippuran clearances. RESULTS: Lowering mean arterial blood pressure decreased GFR and ERPF in both groups. During hypotension ERPF was lower in Group S (n = 5) than Group V (n = 6). Renal function was normalized postoperatively. We found a positive but non-significant correlation between the relative GFR change and the duration of hypotension. CONCLUSION: In conclusion, our study demonstrated that renal function, assessed by GFR and ERPF, is transiently reduced during the combination of hypotensive anaesthesia and acute normovolaemic haemodilution. A colloid-based fluid regime (HES 130/0.4) used for haemodilution may preserve renal function to a greater extent than a crystalloid-based regime (0.9% saline).     

Voluven, a lower substituted novel hydroxyethyl starch (HES 130/0.4), causes fewer effects on coagulation in major orthopedic surgery than HES 200/0.5

Hydroxyethyl starch (HES) solutions are effective plasma volume expanders. Impairment of coagulation occurs with large HES volumes infused perioperatively. Therefore, a lower substituted novel HES (Voluven; Fresenius Kabi, Bad Homburg, Germany) was developed to minimize hemostatic interactions, and was compared with HAES-steril (Fresenius Kabi) (pentastarch) regarding safety and efficacy. We performed a prospective, randomized, double-blinded study in 100 major orthopedic surgery patients. Because the 95% confidence interval (-330 mL; +284 mL) for the treatment contrast Voluven-HAES-steril was entirely included in the predefined equivalence range (+/- 500 mL), comparable efficacy was established. Voluven interfered significantly less than HAES-steril with coagulation factor VIII levels and partial thromboplastin time postoperatively. Total amounts of red blood cells transfused were comparable between the Voluven and HAES-steril groups, but a significantly reduced need for homologous red blood cells was observed in the Voluven group. We conclude that in large-blood-loss surgery, Voluven has a comparable efficacy with HAES-steril and may reduce coagulation impairment, possibly leading to a smaller number of allogeneic blood transfusions. IMPLICATIONS: Hydroxyethyl starches are common plasma volume expanders, but may interfere with coagulation at large doses. We tested a novel hydroxyethyl starch specification (Voluven; Fresenius Kabi, Bad Homburg, Germany) which was developed to reduce hemostatic interactions while preserving its efficacy in restoring plasma volume in comparison to HAES-steril (pentastarch; Fresenius Kabi) in major orthopedic surgery.     

The influence of two different hydroxyethyl starch solutions (6% HES 130/0.4 and 200/0.5) on blood viscosity

We performed the current study to investigate the influence of 2 different hydroxyethyl starch (HES) solutions, the novel medium molecular weight HES 130/0.4 (6%) and HES 200/0.5 (6%), on plasma and whole blood viscosity in vitro and ex vivo in patients with severe head injury. For the in vitro experiments, blood was incubated with increasing concentrations (0%-50% vol/vol plasma) of either 6% HES 130/0.4 or 6% HES 200/0.5 solution. Plasma viscosity and whole blood viscosity (hematocrit [Hct] 45%) at high (94.5 s(-1)) and low (0.1 s(-1)) shear rates were determined. Both HES solutions increased plasma viscosity, but HES 130/0.4 to a lesser extent than HES 200/0.5. Whole blood viscosity was significantly less with HES 130/0.4 than with HES 200/0.5 at concentrations of 37.5% and larger. In the ex vivo study on 31 patients with severe cranio-cerebral trauma treated randomly with either HES 130/0.4 or HES 200/0.5 over several days, frozen plasma samples were thawed and plasma viscosity was determined. Blood was reconstituted with normal erythrocytes (0, Rh neg, Hct 45%) for whole blood viscosity measurements. In both groups plasma and blood viscosity tended to increase over time without statistical significance. Although the prominent effects found in vitro are not in keeping with the ex vivo data, they are likely to reflect the true clinical situation during repetitive, large-dose HES administration. We therefore conclude that HES 130/0.4 may have hemorheological advantages over conventional HES 200/0.5 when used in large quantities.     

术前静脉输注6%羟乙基淀粉200/0.5溶液对患者术后免疫功能的影响

目的 探讨术前静脉输注6%羟乙基淀粉(HES)200/0.5溶液对患者术后免疫功能的影响.方法 择期胆囊切除术患者40例,年龄21～58岁,体重47～79 kg,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为2组(n=20):6%HES 200/0.5组(H组)和复方醋酸钠组(A组).麻醉诱导前经15 min静脉输注6%HES 200/0.5溶液或复方醋酸钠溶液10 ml/kg.于术前、术后1 h、术后1和3 d时取静脉血样,测定血清IL-6、IL-8、TNF-α、IL-2和IL-10以及IgG、IgA和IgM的浓度.结果 与术前比较,两组患者术后血清IL-6、IL-8、TNF-α、IL-2和IL-10浓度均升高,A组术后血清IgA和IgG浓度降低(P＜0.05或0.01),IgM浓度差异无统计学意义,H组上述指标差异无统计学意义(P＞0.05);与A组比较,H组术后血清IL-6、IL-8和TNF-α浓度降低,IL-2、IL-10、IgA和IgG浓度升高(P＜0.05).结论 术前静脉输注6%HES 200/0.5溶液可改善患者术后的免疫功能.

Abstract：

Objective To investigate the effect of 6 % hydroxyethyl starch (HES) 200/0.5 infusion before operation on postoperative immne function in patients. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes aged 21-58 yr weighing 47-79 kg were randomly divided into 2 groups ( n = 20 each): 6% HES 200/0.5 group (group H) and compound sodium acetate group (group A). 6% HES 200/0.5 10 ml/kg or compound sodium acetate solution was infused intravenously over 15 min before anesthesia induction. Anesthesia was induced with iv injection of propofol, fentanyl and vecuronium and maintained with target-controlled infusion of propofol and infusion of remifentanil. Venous blood samples were collected before operation and at 1 h, 1 day and 3 days after operation to detect the serum concentrations of IL-6, IL-8, TNF-α, IL-2, IL-10, IgG, IgA andIgM. Results Serum concentrations of IL-6, IL-8, TNF-α, II-2 and IL-10 were significantly higher after operation in the two groups, and serum concentrations of IgA and IgG were significantly lower after operation in group A than those before operation ( P ＜ 0.05 or 0.01 ). Serum concentrations of IL-6, IL-8 and TNF-α were significantly lower, while serum concentrations of IL-2, IL-10, IgA and IgG were significantly higher after operation in group H than in group A ( P ＜0.05). Conclusion Preoperative infusion with 6% HES 200/0.5 can improve the immune function after operation in patients.     

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.     

失血性休克大鼠输注6%羟乙基淀粉对网状内皮系统功能的影响

目的 观察6％羟乙基淀粉（HES 200／0．5）用于纠正大鼠失血性休克对网状内皮系统功能的影响。方法 30只Wistar大鼠随机分为HES组和对照组（低分子右旋糖酐组）各15只。放血至平均动脉压5.33kPa(1kPa=7.5mmHg)，并用回输或放血方法维持该血压60min，复制失血性休克模型。输入与出血量相同体积的HES或低分子右旋糖酐，分别在复苏后12h(T1)、24h(T2)、48h（T3）、72h(T4)4个时间点，每个时间点分离、纯化3只大鼠肝脏枯否氏细胞（KC）计数KC吞噬Latex 乳胶颗粒的数量。结果 在同一时间点，HES组与低分子右旋糖酐KC吞噬功能无显著性差异；两组输液后任一时间点与T0（未经过休克及复苏，且未输注任一液体）点KC吞噬功能相比无显著性差异。结论 在机体失血量达血容量的20％－30％时输注相同体积的羟乙基淀粉溶液，对肝脏KC吞噬功能无显著影响。     

Intraoperative coagulation was more interfered by HES 200/0.5 than normal saline in off-pump coronary artery bypass surgery

AIM: Rapid fluid administration is often necessary for anesthesiologists to maintain intravascular volume in off-pump coronary artery bypass (OPCAB) with acceptable hematocrits. Postoperative hypocoagulation involving postoperative bleeding and hypercoagulation involving graft patency were focused in previous studies but bleeding and blood transfusion are often peaked during vascular anastomoses during OPCAB. This study is designed to investigate the sequential effects of intraoperative coagulation with normal saline and hydroxyethyl starch (HES) solution by thromboelastography (TEG) and standard coagulation tests (SCT). METHODS: Twenty adult patients scheduled for OPCAB were enrolled in this study. After anesthetic induction, one group received HES 200/0.5 infusion up to 20 mL/kg and the other received 0.9% normal saline (NS) to maintain central venous pressure (CVP) and pulmonary artery occlusion pressures (PAOP). SCT and TEG were measured at T0 (baseline), T1 (after heparin 150 IU/kg, before vascular anastomoses), T2 (after protamine reversal), and T3 (24 hrs after the surgery) to compare the coagulation status. RESULTS: Baseline data were comparable in both groups. The number of patient who need blood components is higher in HES group. Dilutional hypocoagulation was shown by a significant prolongation of R time at T1 and T2 but also returned comparable at T3 in both groups. K, a-angle, CI and G remained unchanged in NS group but significantly affected in HES group. A statistically significant interaction between groups and treatments on maximal amplitude (MA) (P<0.01) with more blood loss in HES group 24 hours postoperatively (P=0.05). International Normalized Ratio (INR) increased significantly at T2 and T3 in both groups. CONCLUSION: A rapid infusion of either normal saline or HES solution to maintain intraoperative intravascular volume induce a significant diluted hypocoagulation during OPCAB. The use of HES solution has a prolonged dilutional hypocoagulation and a significant decrease of MA by specific platelet inhibition effects and more transfusion of blood components. All the above changes were not shown in standard coagulation tests.     

Large-dose hydroxyethyl starch 130/0.4 does not increase blood loss and transfusion requirements in coronary artery bypass surgery compared with hydroxyethyl starch 200/0.5 at recommended doses

BACKGROUND: Hydroxyethyl starch (HES) 130/0.4 may impair blood coagulation less than other HES solutions and, thus, may be used at larger doses without increasing the risk of postoperative bleeding. This study tested the hypothesis that volume replacement with 6% HES 130/0.4 at a dose of up to 50 ml/kg does not increase blood loss and transfusion requirements in elective coronary artery bypass surgery compared with 6% HES 200/0.5 at a dose of up to 33 ml/kg. METHODS: One hundred twenty adult patients scheduled for elective coronary artery bypass surgery were randomized to receive up to 50 ml/kg of 6% HES 130/0.4 or up to 33 ml/kg of 6% HES 200/0.5 for volume replacement during surgery and until 24 h thereafter. Volume requirements in excess of the respective maximum dose of HES were treated with gelatin. Colloid use was at the discretion of the attending physicians and not dictated by protocol. The primary outcome variable was chest tube drainage volume during the first 24 h after surgery. RESULTS: The data from 117 patients (HES 130/0.4, 59 patients; HES 200/0.5, 58 patients) who completed the study according to protocol were analyzed. The median volumes of HES administered were 49 and 33 ml/kg in the HES 130/0.4 and HES 200/0.5 groups, respectively (P < 0.001). Consequently, patients in the HES 130/0.4 group required less gelatin in addition to HES than those in the HES 200/0.5 group (medians: 7 ml/kg vs. 20 ml/kg, P < 0.001). The combined volumes of HES and gelatin were similar for both groups (P = 0.21). The 24-h chest tube drainage (medians: 660 ml vs. 705 ml, P = 0.60) did not differ significantly between the groups, nor did transfusion outcome. CONCLUSION: Six percent HES 130/0.4 at a median dose of 49 ml/kg did not increase blood loss and transfusion requirements in coronary artery bypass surgery compared with 6% HES 200/0.5 at a median dose of 33 ml/kg.     

Effects of two different hydroxyethyl starch solutions (HES200/0.5 vs. HES130/0.4) on the expression of platelet membrane glycoprotein

BACKGROUND: There are various hydroxyethyl starch (HES) solutions with different degrees of hydroxylation and different molecular weights. HES200/0.5 solution is most commonly used. HES130/0.4 is a new HES solution and is the 'state-of-the-art' in volume substitution. However, the mechanism of the observed anticoagulation action of HES has not been fully delineated. The objective of this study was to further investigate the effect of HES200/0.5 and HES130/0.4 on platelet coagulation. METHODS: Sixty ASA I-II patients undergoing elective minor surgery were randomly allocated to receive an intravenous infusion (20 ml/kg) of lactated Ringer's solution (group L), HES200/0.5 (group H) or HES130/0.4 (group V) after the induction of anesthesia. The expression of CD42b, CD41/61 and CD62p in vivo was assessed on non-stimulated platelets and adenosine diphosphate (ADP) agonist-activated platelets using flow cytometry. RESULTS: Resting glycoprotein expression of the non-stimulated platelets was observed. HES200/0.5 and HES130/0.4 reduced the CD42b, CD41/61 and CD62p expression of ADP-agonist-activated platelets at 15 min after intravenous infusion. At 6 h after intravenous infusion, the trend of decreasing expression of activated CD42b, CD41/61 and CD62p was maintained in group H. However, CD42b, CD41/61 and CD62p expression returned to the pre-operative level in group V. CONCLUSION: This study showed that both HES200/0.5 and HES130/0.4 can inhibit platelet coagulation. Platelet dysfunction experienced a faster recovery after the infusion of HES130/0.4 than after HES200/0.5. Liquid resuscitation with HES130/0.4 may decrease the risk of hemorrhage in the operative period.