羟乙基淀粉容量替代治疗对手术患者血流动力学和凝血功能的影响

目的评价不同取代级羟乙基淀粉术中容量替代治疗对普通外科手术患者凝血功能和血流动力学的影响。方法顺序选取67例ASAⅠ~Ⅱ级择期普通外科手术患者,随机分为3组,6%羟乙基淀粉130/0.4组（R1组,23例）和6%羟乙基淀粉200/0.5组（R2组,24例）,林格溶液对照组（C组,20例）,患者术前无肝肾功能异常,血常规、凝血功能各项检查正常,手术前2周未接受抗凝治疗,预计失血量超过400ml,观察其手术前后血流动力学指标及凝血功能指标的变化。结果手术期间各组血流动力学指标稳定、血红蛋白（Hb）、血小板计数（Plt）、血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）差异无统计学意义;与C组比较,R1和R2组患者容量治疗中液体总输入量明显减少,差异有统计学意义（P〈0.05）。结论 6%羟乙基淀粉130/0.4和6%羟乙基淀粉200/0.5是容量替代治疗中有效的扩容剂,在维持血流动力学稳定的同时,可最低限度减少对凝血功能的影响。

Effects of different substitution hydroxyethyl starch in volume replacement therapy on haemodynamic variables and blood coagulation functions

Objective To investigate the effects of different substitution hydroxyethyl starch（HES） for general surgery patients in volume replacement therapy on haemodynamic variables and blood coagulation functions during operation. Methods Sixty-seven patients ASAⅠ-Ⅱ undergoing selective and non-cardiac surgery were assigned randomly to 3 groups：R1 group（6% HES130/0.4group, n=23）, R1 group（6% HES200/0.5 group, n=24） and group C （Ringer locke liquor group, n=20）, hemodynamic and blood coagulation data, the hemoglobin（Hb）, blood platelet count（Plt）,prothrombin time（PT）, activated partial thromboplastin time（APTT） were measured on the day before operation and on the postoperative day 1. Results Hemodynamic variables had no significant difference with the baseline and during each stage time of surgery in each groups, HB, Plt, PT, APTT had no significant difference after the volume replacement therapy in each groups, P0.05. Compared with group C,patients in R1 and R2 groups maintained stable haemodynamics with significant lower dose of infusion volume,P0.05. Conclusion 6%HES 130/0.4 and 6% HES200/0.5 in appropriate dose are safe and effective in volume replacement therapy,and they have little influence on blood coagulation functions.