围术期患者右旋糖酐40急性扩容前后凝血、抗凝、纤溶功能的变化

目的:观察围术期患者使用右旋糖酐40溶液急性扩容后凝血、抗凝和纤溶功能指标的变化。方法:选择ASAⅠ~Ⅱ级全麻下行腹部手术患者40例,麻醉开始后即刻输注复方右旋糖酐40溶液1000ml,持续输注2h。于输注前后采集患者静脉血监测血小板计数(PLT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、纤溶酶原(PLG)、凝血因子VIII活性(FVIII:C)、抗凝血酶活性(AT:A)、活化蛋白C(APC)等凝血、抗凝及纤溶指标的变化。结果:应用右旋糖酐40后,APTT、PT延长,FVIII:C降低,差异有显著性意义(P<0.05~0.01);AT:A、APC和PLG明显降低(P<0.05~0.01)结论:在围术期使用1000ml右旋糖酐40急性扩容对患者的凝血、抗凝和纤溶指标有明显影响,临床应用时需防范其引起出血和血栓形成的危险。

Influences of Rapid Volume Expansion of Dextran 40 Solution on Coagulant and Anticoagulant Function of Patients During Peri-operational Period

Objective: To observe the influences of rapid volume expansion of Dextran 40 solution(1000ml)on coagulant, anticoagulant and fibrinolytic function of patients during peri-operational period.Method: Select forty ASAⅠ～Ⅱpatients scheduled for abdominal surgery under general anesthesia. When the operations started, Dextran 40 solutions were infused instantly and finished in 2 hours. Collect blood samples from veins at two time intervals, 1 hour before induction of anesthesia and 2 hours after induction of anesthesia,PLT, APTT,PT,Fib,PLG and FVIII:C,AT:A,APC activation were tested.Results: Compared with the datas before infusion,APTT,PT prolong, and the difference had remarkable significance. FVIII:C,AT:A,and PLG were all significantly depressed(P<0.05～0.001).Conclusion: Rapid volume expansion of Dextran 40 solution influence coagulant,anticoagulant and fibrinolytic functions significantly during peri-operational period. It brings the risk of hemorrhage and thrombosis, doctors must pay attention to it.