羟乙基淀粉血液稀释对慢性肝病患者血液流变学的影响

目的 体外实验探讨羟乙基淀粉(hydroxyethyl-starch,HES)对慢性肝病患者血液流变学的影响。方法 21例健康人作为对照组,21例慢性肝病患者作为实验组,两组均随机分为HES组(11例)及林格氏液R-L组(10例)。每个实验对象采集贵要静脉血12ml,等分为4个亚组,每组3ml;亚组1为全血基础值,亚组2、3、4分别以6%HES和R-L稀释,使红细胞压积分别降到30%、25%、20%。测定各样本红细胞压积、全血高切粘度、全血中切粘度、全血低切粘度、血浆粘度、红细胞聚集指数、红细胞刚性指数等血液流变学指标。结果 实验组全血红细胞压积显著低于对照组,血浆粘度、红细胞聚集指数显著高于对照组(P<0.05)。HES稀释后,实验组与对照组全血粘度均显著下降(P<0.05),两组间无显著差异(P>0.05);与HES组相比,R-L组全血粘度下降趋势更为显著。HES稀释后,实验组红细胞聚集指数显著下降(P<0.05),亚组3、4与对照组无显著差异(P>0.05);R-L稀释后,实验组与对照组的红细胞聚集指数均显著上升(P<0.05)。HES稀释后,对照组红细胞刚性指数无显著改变,实验组呈升高趋势,但只有亚组4显著高于对照组(P<0.05);R-L稀释后,两组红细胞刚性指数均显著上升(P<0.05)。结论 肝病患者红细胞聚集指数显著增高,用6%HES给肝病患者作适度的血液稀释可降低其全血粘度和红细胞聚集率。

Effects of hydroxyethyl-starch on hemorheology in patients with chronic liver disease

Objective To investigate the effects of hemodilution with hydroxyethyl-starch (HES) on hemorheology in patients with chronic liver diseases in vitro. Methods Twenty-one healthy volunteers were selected as the control group and 21 patients with chronic liver disease as the study group. Both of the two groups were divided into HSE (n=11) and Ringer's solution (n=10) groups. Venous blood of 12 ml were collected from each subject and aliquoted into 4 samples, one of the 4 samples served as control (sample 1), and the other 3 (samples 2, 3, 4 respectively) were diluted with 6% HES or Ringer's solution to cause the hematocrit (Hct) decrease to 30%, 25% or 20%. The rheological parameters including Hct, blood viscosity, plasma viscosity, index of red blood cell aggregation (ARBC) and index of red blood cell rigidity (RRBC) were examined. Results The Hct of the study group was significantly lower than that of the control group (P<0.05), but plasma viscosity and ARBC were significantly higher. After being diluted by HES, the blood viscosity and ARBC decreased significantly in the study group (P<0.05), and were not significantly different from those of the control group (P>0.05) when Hct=25% and 20%. The RRBC of the study group was increased, but the increment was significantly higher than that of control group (P>0.05) only when Hct=20%. Conclusion The ARBC of patients with chronic liver diseases was significantly higher. Hemodilution with 6% HES could significantly reduce the blood viscosity and ARBC.