羟乙基淀粉130／0．4溶液术前扩容对结肠癌患者围术期血液流变学及术后深静脉血栓形成的影响

目的观察羟乙基淀粉（HES）130／0．4溶液术前扩容对结肠癌患者围术期血液流变学及术后深静脉血栓发生率的影响。方法择期行结肠癌根治术的40例患者随机分为两组（n=20）。麻醉诱导时于30min内给两组患者分别输注15ml·kg^-1 HES 130／0．4溶液（HES组）和乳酸钠林格氏（RL）溶液（RL组）。分别于麻醉诱导前（T0）、扩容结束后即刻（T1）、扩容结束后1h（T2）、手术结束后1h（T3）抽取静脉血，检测全血黏度、血浆黏度、红细胞聚集指数（EAI）、纤维蛋白原、血细胞比容（HCT）。采用彩色多普勒超声于术后第7天检查双下肢深静脉血栓形成（DVT）的发生情况。结果与T0比较，HES组T1、T2和T3时全血黏度、血浆黏度、EAI、纤维蛋白原、HCT降低（P〈0．05）。与T0比较，RL组T1时全血黏度、血浆黏度、EAI、纤维蛋白原、HCT降低（P〈0．05），T3时全血低切黏度、红细胞聚集指数增加（P〈0．05）。与RL组比较，HES组T2和T3时全血黏度、EAI、纤维蛋白原和HCT均显著降低（P〈0．05）。HES组术后DVT发生率明显低于RL组（P〈0．05）。结论术前采用HES130／0．4溶液扩容能明显改善结肠癌根治术患者围术期血液流变学指标，并能降低术后DVT的发生率。

The Effect of Preoperative Infusion with Hydroxyethyl Starch 130/0.4 Solution on Hemorheological Parameters of Colon Cancer Patients during Perioperative Period and Postoperative Deep Venous Thrombosis

Objective To investigate the effect of acute hypervolemic hemodilution (AHHD) with hydroxyethyl starch (HES) 130/0.4 solution before surgery on hemorheological parameters of patients with colon cancer during perioprative period. Methods Forty patients undergoing colon cancer radical surgery were randomly divided into 2 groups (n = 20 each): HES 130/0.4 solution group (HES group ) and Ringer's Lactated solution group (RL group ). The two kinds of solution were respectively infused at a dose of 15 ml.kg-1 over a period of 30min before surgery. Blood samples were taken for determination of hemorheology variables before AHHD (T0, baseline), at the end of AHHD (T1), 1 h after the end of AHHD (T2) and 1 h after the end of surgery (T3). DVT was diagnosed by color Doppler ultrasonic system. Results The blood viscosity, plasma viscosity, erythrocyte aggregation index (EAI), fibrinogen and HCT were decreased significantly as compared with the baseline values at T0 in HES group(P < 0.05). The blood viscosity at low shear rate and EAI at T3 were increased significantly as compared with the baseline values at T0 in RL group (P < 0.05). The blood viscosity, plasma viscosity, EAI, fibrinogen and HCT in HES group were lower than those in RL group at T2 and T3 (P < 0.05) . Compared with RL group,the postoperative DVT occurrence significantly decreased in HES group (P < 0.05). Conclusion Loading infusion with HES 130/0.4 solution can ameliorate hemorheology variables in patients with colon cancer during perioperative period and decrease the postoperative DVT occurrence.