不同胶体用于急性高容量血液稀释对老年患者凝血功能的影响  

Effects of Acute Hypervolemic Hemodilution with Synthetic Colloids Differently on Blood Coagulation Functions of the Elderly Patients

作　　者：张冬梅[1] 朱立宏[1] 郎淑慧[1] 徐向辉[2] 常业恬[2] 

机构地区：[1]宁夏医科大学附属医院麻醉科,银川750004 [2]湖南省长沙市中南大学湘雅二医院麻醉科,长沙410011

出　　处：《宁夏医科大学学报》2009年第4期456-458,470,共4页Journal of Ningxia Medical University

摘　　要：目的评价不同人工胶体液进行急性高容量血液稀释（AHH）时对围术期老年患者血流动力学和凝血功能的影响。方法45例ASAⅠ～Ⅱ级择期肝胆、食管肿瘤手术的患者，随机分为对照组（Ⅰ组，n=15），6％羟乙基淀粉组（HAES，Ⅱ组，n=15）和聚明胶肽组（Ⅲ组，n=15）。Ⅱ组和Ⅲ组于术前1h分段实施AHH联合尼卡地平降压，术中均连续监测MAP、HR、SPO2、CVP，分别记录血液稀释前（TO）、诱导后3min（T1）、诱导后10min（1、2）、稀释后15min（1、3）、术毕（T4）上述指标，并于稀释前、稀释后15min，术毕测定血红蛋白（Hb）、红细胞压积（Her）、血小板（Plt）、纤维蛋白原（FIB）、凝血酶原时间（PT）及部分凝血活酶时间（Am）；计量术中尿量、输血量、出血量。结果Ⅱ组和Ⅲ组输血量少于Ⅰ组，而尿量多于Ⅰ组（P〈0．05），AHH前后血流动力学稳定；与110比较Ⅱ组和Ⅲ组Hb、Hct、Plt及Fib显著降低，稀释后与Ⅰ组间差异有统计学意义（P〈0．05），但术毕组间差异无统计学意义（P〉0．05）。PT在AHH后明显延长（P〈0．05），但基本都处在正常范围，且术毕基本恢复术前水平。PTT在AHH后各时点无明显变化（P〉0．05）。结论HAES与聚明胶肽均可以安全有效地用于老年患者的容量替代治疗，且对凝血功能无明显影响。Objective To compare the effect of 6 % hydroxyethyl starch （ HES 200/0.5） and Polyegline on hemodynamic and haemostasis of the elderly patients during in acute hypervolemic hemodilution （AHH） combined with controlled hypotension （CH）. Methods 45 elderly ASA Ⅰ- Ⅱ patients scheduled for elective tumor operation were randomly divided into three groups： control group（group Ⅰ）,AHH with HES（group Ⅱ） or Polyegline （group Ⅲ）, each group containing 15 cases. AHH combined with controlled hypotension was taken as groupⅡ or group Ⅲ into practice before induction and before skin incision. MAP,HR,SPO2 ,CVP were recorded at before AHH （TO）,3min after induction（T1）, 10min after intubation （T2）, 15min after AHH（T3）and at the end of the surgery （T4）. The hemoglobin （Hb）, hematocrit （Hct）, blood platelet count （Pit）, fibrinogen （FIB）, prothronrbin time （PT） and activated partial thromboplastin time（APTT） were measured. The volume of infusion, blood loss and blood transtusion were recorded during the operation. Results The volume of blood transtusion at group Ⅱ and group Ⅲ compared with groupI was lower, but urine volume was increase （ P 〈 0.05）. HR, MAP and CVP remained normal in each groups, Hb,Hct,Plt and Fib decreased gradually after AHH（ P 〈 0.05） ,there were significant difference after AHH between groupI and groupⅡ or groupⅢ（ P 〈 0.05 or P 〈 0.01 ）,but all of that at the end of the surgery no significant difference （ P 〉 0.05）. PT prolonged significantly but still were in normal range, PIT had no significant changes （ P 〉 0.05 ） in groupⅡ and groupⅢ. Conclusion HES and Polyeg-line were safe and effective for aged in AHH, also it had little influence on blood coagulation functions.

关 键 词：急性高容量血液稀释 控制性降压 血浆代用品 凝血功能 

分 类 号：R614[医药卫生—麻醉学]