神经外科术后应用中分子羟乙基淀粉对凝血功能的影响

目的 神经外科患者术后会出现凝血功能亢进,本研究拟使用6％中分子羟乙基淀粉（200/0.5）来进行干预,观察其对凝血的影响.方法 选择全麻下行神经外科开颅手术患者40例,分为实验组（n=20）、对照组（n=20）.对照组术后输注晶体液,实验组术后输注6％中分子羟乙基淀粉10 ml/kg,余输液同对照组.观察病人的血常规、常规凝血功能、Sonoclot凝血功能、无创胸阻抗心功能监测.结果 两组病人术后均未出现严重并发症,对照组PT术后2、3日与术后1日比较明显缩短,Sonoclot凝血斜率和血小板功能较术前都有升高,实验组变化不显著;两组患者血小板计数,心功能状态,尿量均无明显变化.结论 神经外科术后患者凝血机能亢进,有生成血栓的倾向;术后输注羟乙基淀粉可以改善患者术后的凝血功能亢进状态,不加重患者的心功能负担.

The Effects of Medium Molecular Hydroxyethyl Starch on Coagulation Function after Neurosurgical Surgery

Objective Postoperative neurosurgical patients have high risks for the developments of thrombosis with coagulation dysfunction.This incidence of tending to thrombosis should be corrected by using a safety method without increasing morbidity of postoperative intracranial bleeding.The present study was undertaken to test the hypothesis that if the medium molecular hydroxyethyl starch （200/0.5） could attenuate the hypercoagulable state and do not lead to bleeding side effects.Methods Forty adult patients,ASA class Ⅰ to Ⅱ,scheduled for selective craniotomy surgery,were randomly allocated into control group （n =20）,experimental group （n=20）.The experimental group was received 10ml/kg hydroxyethyl starch （200/0.5） infusion per day during the initial 3 postoperative days.The additional fluid managements were same in the 2 groups by standard crystalloid solution and mannitol therapy.Venous blood samples were drawn for Sonoclot coagulation and platelet function analysis,blood parameters and routine coagulation test 1st preoperative day and from 1 to 3rd day postoperatively.The cardiac output measurements by thoracic electrical bio-impedance （TEB） were performed when the blood samples were taken.Results There were no severe complications ineluding intracranial bleeding and/or hydrocephalus,renal dysfunction had been found in all patients during the study.All patients had a significant decrease in RBC,Hb,Hct and an increase in FBG after operation.There were no significant differences at any time of platelet count in all patients.The postoperative prothrombin time （PT） was shortened and the CR,PF of Sonoclot tests were increased in control group compared with preoperative dates.These parameters were no differences in experimental group between preoperative and postoperative dates.No differences were detected between preoperative and postoperative values for any of the cardiac output parameters.Conclusion （1） Postoperative neurosurgical patients have a tendency of hypercoagulable profile that may cause coagulation dysfunction and thrombosis.The infusion of 200/0.5 hydroxyethyl starch （10 ml/kg/day） during the initial 3 days after operation has a benefit to attenuate the hypercoagulable state.（2） The infusion do not lead to cardiovascular system overloaded.（3）The coagulation function should be monitored during postoperative hypercoagulable state therapy.