三种常用晶胶体体外不同程度血液稀释对凝血功能的影响  

Effects of in vitro hemodilution in diverse dilutions with three crystaHoids and colloids commonly used on blood coagulation

作　　者：王卓强[1] 徐震[1] 刘秀珍[1] 范里莉[1] 

机构地区：[1]解放军总医院第二附属医院麻醉科,北京100091

出　　处：《中国急救医学》2009年第4期296-299,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨三种常用晶胶体林格液（Ringer’s solution）、万汶（Voluven）及佳乐施（Gelofusine）体外不同程度血液稀释对凝血功能的影响。方法采用15名成年健康志愿者的静脉血在体外用三种晶胶体分别稀释成30％（体积比，代用品：血液=3：7）、40％（代用品：血液=4：6）、50％（代用品：血液=5：5）、60％（代用品：血液=6：4）等四个浓度，并用未经稀释的全血作为对照。用Sonoclot凝血及血小板功能分析仪进行凝血功能检测，观察包括激活的凝血时间（ACT）、凝结速率（CR）、达峰时间（TP）、血小板功能（PF）等。结果ACT：30％稀释时，林格组较对照组显著缩短（P〈0．05），万汶及佳乐施组与对照组比较差异无统计学意义；40％、50％稀释时，三组与对照组比较差异均无统计学意义；60％稀释时，三组均较对照组显著延长（P〈0．05）。CR：50％稀释时，林格组及佳乐施组与对照组比较差异无统计学意义，万汶组较对照组降低（P〈0．05）；40％稀释时，林格组与对照组比较差异仍无统计学意义，其余两组均显著降低（P〈0．05）；50％、60％稀释时，三组均较对照组显著降低（P〈0．05）。TP：30％稀释时，三组与对照组比较差异无统计学意义；40％稀释时，林格组与对照组比较差异仍无统计学意义，其余两组均显著延长（P〈0．05）；50％、60％稀释时，三组均较对照组显著延长（P〈0．05）。PF：30％稀释时，林格组及万汶组与对照组比较差异无统计学意义，佳乐施组较对照组降低（P〈0．05）；40％、50％、60％稀释时，林格组与对照组比较差异仍无统计学意义，其余两组均显著降低（P〈0．05）。结论血液稀释后凝血功能与稀释液种类及血液稀释程度相关。在三种常用晶胶体中，林格液对凝血功能的影响最小，当其稀释度不超过50％时就不致引�Objective To investigate the effects of in vitro hemodilution in diverse dilutions with three crystalloids and colloids commonly used （Ringer＇s solution, Voluven and Gelofusine） on blood coagulation. Methods 15 healthy adult volunteers were enrolled. Venous blood samples gotten from each volunteer were diluted with three crystalloids and colloids respectively by 30% （volume ratio, substitute： blood = 3： 7）, 40% （substitute： blood = 4： 6）, 50% （substitute： blood = 5： 5）, 60% （substitute： blood = 6：4 ）. Undiluted blood was considered as control group. Coagulation of each group was measured with Sonoclot coagulation and platelet function analyzer. The parameters included activated clotting time （ACT） , clot rate （CR） , time to peak （TP） , platelet function （PF） were measured. Results ACT： at 30% dilution, ACT was significantly shortened in Ringer＇s solution group compared with control group （ P 〈 0. 05 ）, but no significant difference was detected in Voluven and Gelofusine groups compared with the control group; at 40% and 50% dilution, ACT were not affected markedly by three crystalloids and colloids; at 60% dilution, however, ACT was significantly prolonged by three crystalloids and colloid compared with the control group （P 〈 0. 05）. CR：at 30% hemodilution, the CR reduced significantly in Voluven group compared with the control group （P 〈 0.05） , but no significant changes were observed in the Ringer＇s and Gelofusine groups ; at 40% dilution, CR were reduced in Voluven and Gelofusine groups （ P 〈0. 05 ）, but no obvious change was found in Ringer＇s group; at 50% and 60% dilution, CR were reduced in all three groups compared with the control group （P 〈 0.05 ）. TP： at 30% dilution, no significant difference was found in all three groups compared with the control group ; at 40% dilution, no significant change was observed in the Ringer＇s group, but TP was significantly prolonged by other two colloids compared with th

关 键 词：血液稀释 凝血功能 林格液 万汶 佳乐施 

分 类 号：R457.1[医药卫生—治疗学]