不同取代级羟乙基淀粉对血小板膜糖蛋白表达的影响  

Effect of bydroxyethyl starch with different degrees of substitution on expression of platelet membrane glycoprotein

作　　者：陈钢[1] 姚媛媛[1] 柳子明[1] 周海燕[1] 吕庆华[1] 严敏[1] 

机构地区：[1]浙江大学医学院附属第二医院麻醉科,杭州市310009

出　　处：《中华麻醉学杂志》2006年第10期901-903,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨不同取代级羟乙基淀粉对血小板凝血功能的影响。方法择期行外科小手术患者60例,ASAⅠ级,年龄25～45岁,体重51～70 kg,随机分为乳酸钠林格氏液组(LR组)、HES 200／0．5组(H组)和HES 130／0．4组(V组),每组20例。麻醉诱导后,3组患者分别静脉输注乳酸钠林格氏液、HES 200／0．5和HES 130／0．4 20 ml·k-1,30-60 min内输注完毕。采用流式细胞术测定3组患者在术前(T1,基础值)、输注完毕后15 min(T2)、输注完毕后6 h(T3)各时点静脉血中静息态血小板与活化态血小板CD42b、CD61／41、CD62p的表达。结果3组患者输注前后静息态血小板膜糖蛋白表达差异无统计学意义(P>0．05)。与基础值比较,H组和V组T1时ADP活化血小板CD42b、CD61/41、CD62p表达降低(P<0．05或0．01),H组T3时以上指标表达降低(P<0．01),V组T3时以上指标表达差异无统计学意义(P>0．05)。结论HES 130／0．4抑制血小板凝血功能的程度较HES 200／0．5低。HES 130／0．4液体治疗有助于降低术后出血的发生。Objective To investigate the effect of hydroxyethyl starch （HES） with different degrees of substitution on coagulation of platelets. Methods Sixty ASA class I patients of both sexes （26 males, 34 females） aged 25-45 yrs weighing 51-70 kg undergoing elective minor surgery were randomized to receive lactated Ringer＇s solution （LR group） or HES 200/0.5 （HES group） or HES 130/0.4 （Voluven group） 20 ml·kg^-1 after induction of anesthesia （n = 20 each）. Venous blood samples were taken before surgery （T1, baseline）, at 15 min （T2 ） and 6 h （ T3 ） after LR or HES infusion for determination of the expression of platelet membrane glycoprotein （GP）, CD42b, CD61/41, CD62p by flow cytometry. Results There was no significant change in the expression of GP on the resting platelet after infusion of LR or HES in all patients. The expression of CD2b, CD61/41 and CD62p on the platelet activated by ADP was significantly decreased at 15 min after lIES infusion as compared to the baseline at T1 in both HES and Voluven groups （ P 〈 0.05 or 0.01）. The expression of CD42b, CD61/41 and CD62p was still significantly lower at 6 h after HES infusion than the baseline values in HES group （ P 〈 0.01 ） while in Voluven group the expression of GP returned to the preoperative baseline level. Conclusion HES 200/0.5 and to a lesser degree HES 130/0.4 can both inhibit coagulation of platelet. Fluid therapy with HES 130/0.4 can decrease the risk of hemorrhage in postoperative period.

关 键 词：羟乙基淀粉 补液疗法 血小板膜糖蛋白类 

分 类 号：R614[医药卫生—麻醉学]