扩容性血液稀释对凝血功能及电解质的影响

为对比观察乳酸钠林格液、海脉素和佳乐施用于扩容性血液稀释期间凝血功能及电解质的变化。将 30例颅脑手术病人分为乳酸钠林格液组 (Ⅰ组 )、海脉素组 (Ⅱ组 )和佳乐施组 (Ⅲ组 ) ,麻醉诱导后 ,分别用相应液体以 2 5mL/min的速度扩容 ,分别于麻醉诱导后、输液 50 0mL、1 0 0 0mL、1 50 0mL及完成扩容后 30min时测定红细胞比容(Hct)、活化部分凝血激酶时间 (APTT)、血浆凝血酶原时间 (PT)、血清钙离子浓度 (Ca2 +)。结果 :Ⅰ组扩容期间 ,Hct逐渐降低 ,输入 1 50 0mL液体后 ,Hct降低 1 0 .8% ,APTT、PT及Ca2 +无明显变化。Ⅱ组扩容期间 ,Hct逐渐降低 ,Ca2 +逐渐增高 ,输入 1 50 0mL液体后 ,Hct降低 2 4 .1 % ,Ca2 +增高 8.3% ,APTT和PT无明显变化。Ⅲ组扩容期间Hct和Ca2 +逐渐降低 ,APTT和PT逐渐延长 ,输入 1 50 0mL液体后 ,Hct降低 2 5.5% ,Ca2 +降低 1 2 .5% ,APTT和PT分别延长 2 1 .0 %和 1 4 .0 %。提示麻醉诱导后用海脉素和佳乐施行扩容性血液稀释效果优于乳酸钠林格液 ;对于Ca2 +偏低的病例 ,宜用海脉素扩容 ;对于术前已有凝血功能障碍及Ca2 +下降的病例慎用佳乐施扩容

Changes of Coagulation and Electrolyte during Hypervolemic Hemodilution

To compare the changes of coagulation and electrolyte during hypervolemic hemodilution induced by lactated Ringer′s solution(LR), haemaccel(H)or gelofusine(G), 30 neurosurgical patients without heart diseases were randomly allocated into three groups. Hypervolemic hemodilution was induced by rapid infusion, 25 mL/min, in patients of LR(group LR, n=10), H(group H, n=10)or G(group G, n=10)after general anesthesia. Hematocrit(Hct), activate partial thromboplastin time(APTT), prothrombin time(PT)and calcium concentration in serum(Ca²⁺)were tested after anesthesia induction, infusion of 500 mL, infusion of 1 000 mL, infusion of 1 500 mL, and 30 min after hypervolemic hemodilution, respectively. Results: During hypervolemic hemodilution, Hct decreased by 10.8% after 1 500 mL infusion of LR, while APTT, PT and Ca²⁺ did not change significantly in group LR. In group H, Hct decreased by 24.1%, Ca²⁺ increased by 8.3%, APTT and PT did not change significantly after 1 500 mL infusion of H. In group G, Hct and Ca²⁺ decreased by 25.5% and 12.5% respectively, APTT and PT prolonged 21.0% and 14.0% respectively after 1 500 mL infusion of G. The result shows that H and G used for hypervolemic hemodilution are better than LR; H is suitable for the patients with low serum Ca²⁺; and G should not be used for patients with coagulation disorder.