羟乙基淀粉130/0.4急性高容量血液稀释对血液流变学和凝血功能的影响  

Influence of HES130/0.4 acute hypervolemic hemodilution on hemorheology and blood coagulation of malignant tumor patients

作　　者：秦秦[1] 杨瑞[1] 龙卫红[1] 白宁[1] 张昕[1] 

机构地区：[1]陕西省人民医院麻醉科,西安市710068

出　　处：《临床麻醉学杂志》2009年第3期221-224,共4页Journal of Clinical Anesthesiology

基　　金：陕西省社发攻关项目(项目编号:2007K09-07)

摘　　要：目的观察6%羟乙基淀粉(HES)130/0.4急性高容量血液稀释(AHH)对高凝状态的恶性肿瘤患者血液流变学和凝血功能的影响。方法择期在全麻下行胃、肠癌根治术伴高凝状态患者40例,随机分为两组,每组20例。全麻插管后H组输注HES130/0.4,R组输注复方乳酸钠,均以15～20ml/kg(25～35ml/min)输注。分别于AHH前(T0)、AHH结束后即刻(T1)、AHH结束后60min(T2)和手术结束时(T3)采静脉血检测血液流变学和凝血功能。结果H组AHH后各时点全血高切粘度、低切粘度、血浆粘度、血细胞比容(Hct)及血小板聚集率明显低于T0时(P<0.05);H组AHH后各时点Hb、血小板计数(Plt)低于R组(P<0.05);H组AHH后各时点部分活化凝血活酶时间(APTT)较R组明显延长(P<0.05),但两组均在正常范围;H组纤维蛋白原(FIB)降低更为显著(P<0.05)。结论HES130/0.4AHH用于恶性肿瘤患者能改善血液流变学,改善肿瘤患者的高凝状态,但对凝血功能的影响较小。Objective To study the influence of acute hypervolemic hemodilution with hydroxyethyl Starch （HES）130/0.4 on hemorheology and blood coagulation of malignant tumor patients. Methods Fourty patients with hypercoagulability undergoing radical operation of gastroenteral cancers were divided into two groups with 20 cases each. Patients in group H were infused VIES 15-20 ml/kg（25-35 ml/min）, and those in group R lactated Ringers solution instead of HES. The vein blood was taken before AHH（T0 ）, at completion of infusion（T1 ）, 60 rain after AHH （T2） and the end of operation（T3 ） for the measuerments of hemorheology and blood coagulation. Results The whole low blood viscosity,plasma viscosity, Vict and platelet aggregation rate in group H were significantly reduced after AHH competed to those at To （P〈0. 05）. Hb and Pit at （T1-T3） were lower in group H than those in group R （P〈0. 05）. APTT was prolonged remarkably after AHVI competed to that at To, but which was still in the normal range. Fibrogen after AHH was decreased more in group H than that in group R （P〈0. 05）. Conclusion AHH with HES can reduce the patient＇ s blood viscosity, Hct, and platelet aggregation, improve blood hemorheology characteristics in cancer patients with hypercoagulability without influencing the blood coagulation.

关 键 词：高凝状态 血液稀释 血液流变学 凝血功能 

分 类 号：R614[医药卫生—麻醉学]