高渗氯化钠羟乙基淀粉40注射液对老年患者凝血功能的影响

目的通过临床研究预注高渗氯化钠羟乙基淀粉40注射液（HSS40）对老年患者凝血及血小板功能的影响．探讨HSS40在老年患者的临床应用可行性。方法选择ASAⅠ～Ⅱ级，20例老年、神经外科手术患者，所有患者均采用静吸复合麻醉。人室后局麻下行桡动脉及颈内静脉穿刺，以4ml／kg输注HSS40，30分钟内输注完毕。分别在输注HSS40前、输注HSS40完毕即刻、输注后30min、60min监测：①凝血酶原时间（PT）、纤维蛋白原（FIB）、部分凝血活酶时间（APTT）；②应用Sonoclot分析仪测定初期凝血形成时间（ACT onset）、纤维蛋白形成速率（凝血速率Clot Rate）和血小板功能（PF）；③K^＋、Na^＋、Ca^2＋、HCT、HB等血气和血糖指标。结果与输注HSS40前相比，输注HSS40即刻APTT延长（P〉0．05）、PT明显延长（P〈0．05）．输注毕30min APTT、PT延长达到最高峰（P〈0．05），输注毕60min逐渐恢复正常（P〉0．05）；输注HSS40对FIB的影响统计学上无意义岭0．05）；输注HSS40前后ACT、Clot Rate、PF的改变统计学上无意义（P〉0．05）；K^＋浓度降低，统计学上无意义（P〉0．05）：Na^＋浓度升高，输注HSS40即刻改变最为明显（P〈0．05），之后逐渐恢复，输注毕60min基本恢复至入室时基础值（P〉0．05）；Ca^2＋浓度没有明显改变（P〉0．05）；HCT、HB随着输注液体的增加逐渐降低，与入室时相比P〈0．05；各时间点血糖没有明显改变（P〉0．05）。结论适量输入HSS40（4ml／kg）对老年患者凝血及血小板功能和电解质、血糖无明显影响．可安全应用于临床。

The influence of injecti ng hypertonic sodium chloride hydroxylethyl starch 40 on blood coagulation of old patient

Objective To evaluate the influence of hypertonic sodium chloride hydroxylethyl starch 40 （HSS40）on blood coagulation,platelet function,electrolytes and blood glucose of old patient. Methods ASA Ⅰ - Ⅱ, twenty old patients of neurosurgical procedures were observed. All received general anesthesia. Radial artery and right jugular veins were catheterized under local anesthesia in all patients. HSS40 was injections at 4ml/kg during 30min after vein catheterization. To record PT, APTT,FIB,ACT,Clot Rate,PF and K^＋,Na^＋,Ca^2＋,HCT,HB ,blood glucose before intravenous infusing HSS40,after infusing and 30min,60min later.Results Compare with before infusing HSS40 and 60min later, APTT and PT were much higher after infusing 30min（P〈0.05 ）and reeovery normal after infusing 60min. There was no significant difference on FIB ,ACT,Clot Rate and PF （P〉0.05）. The altered of Na^＋ was much higher at 30min （P〈0.05）. There was no significant difference on K^＋ and Ca^2＋ and blood glucose （P〉0.05）. Conclusion HSS40 is no influence on blood coagulation, platelet function,electrolytes and blood glucose, it may be valuable for clinical application.