比较不同分子量羟乙基淀粉对术中血液循环及凝血功能的影响

目的多中心、双盲、平行对照比较术中输注国产6%羟乙基淀粉200/0.5(6%HES200/0.5,盈源)和6%羟乙基淀粉130/0.4(6%HES130/0.4,万汶)对术中血流动力学、血液流变学及凝血功能的影响。方法150例择期手术的患者随机均分为Y组和V组。手术开始后,Y组输注6%HES200/0.51000ml,V组输注6%HES130/0.41000ml。分别于麻醉前(T0)、输注开始时(T1)、输注开始后30min(T2)、60min(T3)、90min(T4)、120min(T5)各时点监测患者血流动力学参数,在麻醉前及输注结束后10min抽血检测凝血功能及血液流变学参数。结果与T0时相比,两组患者T1时MAP均明显下降(P<0.05),V组T4、T5时MAP明显降低(P<0.05);T3时V组HR增快(P<0.05),输液结束后两组凝血酶原时间(PT)及部分凝血酶原时间(APTT)均有所延长(P<0.05),纤维蛋白原下降(FIB)(P<0.05),血小板计数(Plt)减少(P<0.05),但两组组间差异无统计学意义;两组液体均可降低全血高、低切变率(P<0.05),对血浆粘度无明显作用。两组术中输血量及晶体输入量差异无明显统计学意义。结论输入6%HES200/0.5或6%HES130/0.41000ml均可有效维持血流动力学稳定,改善机体微循环,但对凝血功能均有尚可耐受的影响。

Effects of hydroxyethyl starch solution on circulation and coagulation function

Objective To compare the effects of 6% hydroxyethyl starch (HES 200/0.5) and 6%HES130/0.4(voluven) on haemodynamics,hemorheology and coagulation function in surgical patients. Methods One hundred and fifty patients undergoing selective operation were randomized into two groups with 75 cases each. HES 200/0.5 (group Y) or 6%HES130/0.4 (group V) 1000ml was infused after the surgery began. Blood pressure,heart rate,SpO2 and ECG were monitored before operation (T0),at the beginning of infusion (T1),and 30min (T2),60min(T3),90min(T4),120min(T5) after infusion. Parameters of coagulation and rheology were evaluated at T0 and T5. Results There was no obvious difference in haemodynamics between the two groups. PT and APTT were significantly prolonged,and fibrinogen and platelet count was reduced after infusion compared with those before in both groups (P<0.05),which were not significantly different between the two groups. There was a marked influence of two fluids on whole blood viscosity(P<0.05),but not plasma viscosity. The amount of surgical bleeding and crystalloids infusion was similar in both groups. Conclusion Infusion of 6%HES200/0.5 or 6%HES130/0.4 1000 ml can maintain haemodynamics stabile and improve microcirculation,but impact blood coagulation,although the parameters were still in normal range.