等容血液稀释对家兔大出血时凝血功能的影响

目的研究等容血液稀释和肝出血自体血复苏中不同溶液对凝血功能的影响。方法将18只新西兰家兔建立等容血液稀释和肝出血自体血复苏模型,根据手术中输注的不同等容血液稀释溶液随机分为羟乙基淀粉130/0.4组（H组）、琥珀酰明胶组（G组）和乳酸钠林格液组（RL）,每组6只。于家兔麻醉后血液稀释前（T0）、等容血液稀释后10min（T1）、肝出血自体血复苏后60min（T2）抽取动脉血样,行常规凝血功能和凝血弹性描记仪（TEG）指标检测;并观察肝出血自体血复苏120min内各组家兔的生存情况和失血量。结果与T0时间点比较,H组T1、T2时间点各项凝血功能指标均有统计学差异（P〈0.05）;与T1时间点比较,H组T2时间点TEG各项指标也有统计学差异（P〈0.05）。H组家兔的生存时间更短,失血量更多。肝出血自体血回输期间,H组的平均动脉压（MAP）呈下降趋势,与G组和RL组比较差异均有统计学意义（P〈0.05）。结论羟乙基淀粉130/0.4较琥珀酰明胶和乳酸钠林格溶液的凝血抑制作用更强。

Effects of normovolemic dilution on coagulation function of hemorrhage in rabbits

Objective To investigate the effects of different resuscitation fluids on coagulation function of normovolemic hemodilution and autologous blood transfusion after hepatic hemorrhage. Methods Models of normovolemic hemodilution and autologous blood resuscitation after hepatic hemorrhage were established in 18 New Zealand rabbits, and were randomly divided into H group (Hydroxyethyl starch 130/0.4), G group (Gelofusine) and RL group (Ringer lactate) according to different resuscitation fluids (n=6 in each group). Blood samples were collected from femoral arteries after anesthesia and before hemodilution (T0), 10 min after normovolemic dilution (T1) and 60 min after autologous blood resuscitation after hepatic hemorrhage (T2). Coagulation function was tested, and thromboelastograph (TEG) measurements were conducted. Besides, time of survival and volumes of blood loss were monitored in each group within 120 min of resuscitation after hepatic hemorrhage. Results Parameters of coagulation function at T1 and T2 time points were significantly different from those at T0 time point in H group （P<0.05）. There were also significant differences in TEG measurements between T1 time point and T2 time point in H group （P<0.05）. Time of survival was shorter, and volume of blood loss was larger in H group. There was a decrease tendency of mean artery pressure (MAP) during autologous blood transfusion after hepatic hemorrhage in H group, and was significantly different from those of G group and RL group （P<0.05）. Conclusion Hydroxyethyl starch 130/0.4 has a greater inhibitive effect on coagulation function than Gelofusine and Ringer lactate.