羟乙基淀粉130／0．4对老年患者凝血功能和血小板功能的影响  

Effects of hydroxyethyl starch 130/0.4 on blood coagulation function and platelet function in the elderly

作　　者：黄贞玲[1] 王珊娟[1] 周仁龙[1] 张马忠[1] 杭燕南[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,200001

出　　处：《中华麻醉学杂志》2009年第5期431-434,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价6％羟乙基淀粉130／0．4对老年患者凝血功能和血小板功能的影响。方法择期行胃肠肿瘤切除术老年患者30例，年龄65～85岁，体重45～85kg，ASAI或Ⅱ级，随机分为HES组和生理盐水组（NS组），每组15例。麻醉诱导气管插管后吸人异氟醚（呼气末浓度0．5％～1．5％）维持麻醉，两组分别于气管插管后以10～15Ⅱd·kg^-1·h^-1的速率经颈内静脉输注6％羟乙基淀粉130／0．4注射液、生理盐水25ml／kg。分别于输注前、输注完毕30min、4h时肘静脉抽血样，测定血红蛋白浓度（Hb）、血小板计数（Pit），凝血酶原时间（PT）、激活部分凝血酶原时间（APTY）、纤维蛋白原（FIB）、血浆Ⅷ因子和假性血友病因子（vWF），Sonoclot血小板功能分析仪测定玻璃珠激活全血凝固时间（gbACT）、凝血速率及血小板功能。结果两组输注完30min、4h时Hb与Plt较输注前明显降低（P〈0．01）；两组输注前后PT、APTT、FIB、血浆Ⅷ因子和vWF差异均无统计学意义（P〉0．05）；两组输注前后gbACT、凝血速率及血小板功能差异均无统计学意义（P〉0．05）。结论术中输注6％羟乙基淀粉130／0．425ml／kg对老年患者凝血功能和血小板功能无明显影响。Objective To assess the effects of hydroxyethyl starch （HES）130/0：4 on blood coagulation function and platelet function in the elderly. Methods Thirty elderly patients undergoing gastric and intestinal tumor resection under general anesthesia were randomly assigned to one of 2 groups （ n = 15 each） ： HES group and normal saline group （group NS）. The patients were premedicated with im phenobarbital 0.1 g and scopolamine 0.3 rag. Anesthesia was induced with midazolam 0.02-0.05 mg/kg, fentanyl 3-5 μg/kg, propofol 1-2 mg/kg, veeuronium 2 mg and suceinylcholine 1-1.5 mg/kg and maintained with isoflurarte （end-tidal concentration O. 5 %- 1.5% ） and intermittent iv boluses of fentanyl and vecuronium after tracheal intubation. HES or NS 25 ml/kg was infused after tracheal intubation at a rate of 10-15 ml· kg^-1 · h^-1 through central venous line. Venous blood samples were taken before （% , baseline） and at 30 rain （T2） and 4 h （T3 ） after HES or NS infusion for determination of hemoglobin （Hb）, platelet count （Pit）, prothrombin time （PT）, activated partial thromboplastin time （AFFr） and fibrinogen level （FIB）, plasma factor Ⅷ, van Willebrand factor （vWF）. Glass bead activated whole blood clotting time （gbACT）, clot rate and platelet function were also measured at the 3 time points using Sonoclot analyzer. Results The 2 groups were comparable with respect to M/F sex ratio, age, body weight and duration of operation. Hb and Pit were significantly decreased at T2 and T3 after HES or NS infusion as compared with the baseline values at T, before infusion. There was no significant change in PT, AFFr, FIB, Ⅷ ,vWF, gbACT, clot rate and PIT function after infusion in both groups. Conclusion Infusion of HES 130/0.4 25 ml/kg during operation does not have significant effects on blood coagulation function and platelet function in the elderly.

关 键 词：羟乙基淀粉 老年人 血液凝固试验 血小板功能试验 

分 类 号：R614[医药卫生—麻醉学]