羟乙基淀粉HES130/0.4预扩容对颅脑外伤患者围术期血流动力学及凝血功能的影响  

Effect of volume expansion with Hydroxyethyl Starch 130/0.4 Solution on perioperative hemodynamics and coagulation function in patients with traumatic brain injury

作　　者：何焕钟[1] 周惠芬[1] 钱玉芳[1] 徐恒艺[1] 闫仁福[2] 孟志鹏[1] 王钱荣[1] 闵辉[3] 

机构地区：[1]湖州市中心医院麻醉科,浙江313000 [2]湖州市中心医院神经外科,浙江313000 [3]湖州市中心医院检验科,浙江313000

出　　处：《中国急救医学》2010年第9期796-799,共4页Chinese Journal of Critical Care Medicine

基　　金：湖州市科技局资助项目（No.2008ys34）

摘　　要：目的 研究羟乙基淀粉HES130/0.4（万汶）预扩容对颅脑外伤患者围术期血流动力学及凝血功能的影响.方法 选择40例颅脑外伤需手术治疗的成年患者,随机分为羟乙基淀粉HES130/0.4（万汶）组和对照组.分别在麻醉诱导前20 min给予500 mL的万汶和1000 mL平衡液,在输液前（T0）及输液后10 min（T1）、20 min（T2）和颅骨板切开后1 min（T3）、10 min（T4）抽取非输液侧的静脉血2 mL用于测定血红蛋白（Hb）、红细胞压积（Hct）,并观察血液动力学的变化,计算血容量（BV）、液体潴留量（FR）及容量扩张效率（VEE）;在术前（基础值）,预扩容完成时及术毕三个时点抽取静脉血样测定凝血酶原时间（PT）,部分激活的凝血酶原时间（APTT）,纤维蛋白原（FIB）,D-二聚体（D-D）及凝血因子Ⅷ.结果 预扩容完成后,两组的血流动力学参数比较无明显差异;颅骨板切开后1、10 min的血流动力学参数万汶组明显优于对照组;预扩容后20 min,留在血管内的液体百分比对照组平均只有41.7%,而万汶组为91.2%,对照组留在血管内的液体（FR%）明显比万汶组少;术毕时万汶组患者APTT、PT值及FIB和D-D均较基础值延长,并且与对照组比较差异有统计学意义（P〈0.05）.万汶组术毕后血小板值和Ⅷ因子活性也较基础值有明显下降（P〈0.05）;而且与对照组比较差异有统计学意义（P〈0.05）.结论 与输注平衡液比较,急诊颅脑外伤患者麻醉前应用500 mL万汶预扩容可维持麻醉诱导及颅骨板切除时的血流动力学稳定,但其对颅脑外伤患者凝血功能的影响尚需进一步的研究.Objective To investigate the effect of volume expansion with Hydroxyethyl Starch 130/0. 4 Solution on perioperative hemodynamics and coagulation function in patients with traumatic brain injury. Methods 40 patients with head injury required surgery were randomly to divided into two groups with 20 cases each. 1000 mL lactated Ringer＇s solution （LR） was administered during 20 min before general anesthesia in control group, and 500 mL 6% hydroxyethylstarch （HES） in Study group （HES group）. Coagulation studies were performed before the induction of anesthesia, after infusion of 6% lIES or the Compound Sodium Chloride and the time the operation completed, sample was drawn for the measurements of blood prothrombin time （ PT）, activated part of the Prothrombin time （ APTT ）, Fibrinogen（FIB） , D - dimer（ D - D） , coagulation factor vm （ FV~： C） and blood platelets. Mean arterial blood pressure （ MAP）, heart rate （HR） and central venous pressure （CVP） were measured and arterial blood gas analysis was performed at the following time points： immediately before anesthesia ,just 10 min,20 rain after anesthesia, 1 min, 10 min after craniotomy. The MAP, HR, CVP were compared. Results The MAP, HR, CVP of the HES group in 1 min, 10 min after craniotomy was significantly better than the control group ; the values of APTI＇, PT, FIB and D - D of the HES group were longer than that the control group after surgery（P 〈0. 05 ）. The amount of blood platelet and coagulation factor Ⅷ activity were decreased more than that the control group after surgery （ P 〈 0. 05 ）. Condusion Compared with 1000 mL lactated Ringer＇s solution（LR）, rapid plasma volume expansion with 500 mL Hydroxyethyl Starch 130/0.4 Solution before anesthesia could maintain better blood hemodynamics in patients with acute traumatic brain injury, but it were suggested to further study effect on perioperative coagulation function with 500 mL Hydroxyethyl Starch 130/0. 4 Solution.

关 键 词：颅脑外伤 羟乙基淀粉HES130/0.4 液体治疗 凝血 血流动力学 

分 类 号：R445.1[医药卫生—影像医学与核医学]