血栓弹力图检测羟乙基淀粉对凝血功能的影响

目的用血栓弹力图(TEG)检测剖宫产手术麻醉前预扩容乳酸林格液和6%羟乙基淀粉对凝血功能的影响。方法选择ASAⅠ~Ⅱ级,拟行剖宫产手术的患者40例,随机分成两组:乳酸林格液(LR)组和6%羟乙基淀粉(HAES)组。抽取3mL静脉血测血栓弹性描记图。LR组麻醉前输乳酸林格液1000mL,HAES组麻醉前输6%羟乙基淀粉500mL。用30min输完。输液完成后再次测量TEG。患者在腰硬联合麻醉下行剖宫产术。结果输液体前两组之间血色素、血小板计数差异无统计学意义(P>0.05)。LR组和HAES组的TEG基础值相似。预扩容后,HAES组的r时间和k时间延长,与扩容前的差别有统计学意义(P<0.05),但仍然在正常参考值范围内。LR组预扩容后的r时间和k时间与扩容前的数值相似,差别无统计学意义(P>0.05)。结论6%HAES 500mL预扩容虽TEG凝血指标有所影响,但凝血功能仍在正常范围内;乳酸林格液1000mL预扩容不影响凝血功能。

Effect of hydroxyethyl Starch Preloading before Cesarean Section

Objective To investigate effects of preloading lactate Ringer＇ s solution and 6% hydroxyethyl starch （HAES） on coagulation using thromboelastography （TEG）. Methods 40 parturients, ASA Ⅰ -Ⅱ, planned for elective sesarean section were randomized to 2 groups： group LR and group HAES. Check baseline thromboelastography. Patient receive lactate Ringer＇ s solution 1000mL for LR group, receiving 6% hydroxyethyl starch 500mL for HAES group. Repeat TEG after crystalloid or colloid infusion. Patient then received pinal anesthesia followed by sesarean section. Results Before infusion, there was no difference of hemoglobin and platelet counts between the two groups （P〉0.05）. After preloading, r time and k time of HAES group increase compared to baseline, the difference is statistically significant （P〈0.05）. These TEG values remained in normal reference range. There was no difference of ＂lEG values between preloading and baseline in LR group. Conclusion Preloading of 6% HAES 500mL mildly influence on TEG value, but coagulation was normal. Preloading of lactate Ringer＇ s solution 1000ml does not effect on coagulation.