不同种类液体行离体血液稀释对凝血功能的影响  

Effect of in vitro hemodilution with different fluids on coagulation function

作　　者：龚玲[1] 金善良[1] 金珏[1] 于布为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,200025

出　　处：《上海医学》2011年第2期109-113,83,共5页Shanghai Medical Journal

基　　金：上海市自然科学基金资助项目(03ZR14046)

摘　　要：目的通过比较乳酸林格液、羟乙基淀粉130/0.4氯化钠注射液(万汶)、高渗氯化钠羟乙基淀粉40溶液(霍姆)行离体血液稀释后凝血功能的变化,为临床安全开展超容量液体填充及液体治疗提供参考依据。方法 择期行腔镜外科手术的患者36例,随机分为乳酸林格液组(RL组)、羟乙基淀粉130/0.4组(HES组)、高渗氯化钠羟乙基淀粉40组(HM组),每组12例。于麻醉前取静脉血10mL,在离体恒温37℃环境下分别以10∶1、10∶4、10∶10(RL、HES组)稀释度或10∶0.5、10∶1、10∶4(HM组)稀释度在聚乙烯试管内进行血液稀释,通过血栓弹性描记图(TEG)检测稀释前后的凝血功能变化,记录各组液体不同稀释点的TEG结果[反应时间(R)、血凝块形成时间(K)、角度(α角)、最大振辐(MA)、凝血指数(CI)]及红细胞压积(Hct)、胶体渗透压(COP)数值,并在光学显微镜下观察血细胞大体形态的变化。结果 RL组中,与10∶10稀释比例比较,10∶4稀释比例的R、K值显著缩短(P值均<0.05),α角、MA显著增大(P值均<0.05)。HES组中,10∶1、10∶4稀释比例时的TEG各项主要参数仍在正常范围内,10∶10稀释比例时的R、K值较全血及10∶1稀释比例时显著延长(P值均<0.01),α角、MA显著减小(P值均<0.05)。HM组中,10∶0.5、10∶1稀释比例时的TEG各项主要参数均在正常范围内,在10∶4稀释比例时的R、K值较全血及10∶0.5、10∶1稀释比例时显著延长(P值均<0.01),α角、MA显著减少(P值均<0.01),偏离正常值范围。随着稀释程度的增加,RL组的COP逐渐减小,其余两组则逐渐增大,RL组和HES组的稀释比例为10∶10时,与全血的差异均有统计学意义(P值均<0.05)。高倍光学显微镜下,血细胞大体形态无明显异常表现。结论 乳酸林格液稀释可以引发血液高凝状态,以中度血液稀释为甚。羟乙基淀粉130/0.4在轻度稀释时对凝血指标的影响不大,中度、极度血液稀释可导致血液趋向低凝�Objective To compare the effects of in vitro hemodilution with lactated ringer＇s solution,hydroxyethyl starch 130/0.4 and hypertonic sodium chloride hydroxyethyl starch 40 on the coagulation function,so as to provide evidences for safe clinical application of acute hypervolemic fluid infusion and fluid therapy.Methods Thirty-six patients undergoing elective laparoscopic surgery were randomly assigned to three groups（n=12）：groupⅠ,lactated Ringer＇s solution（RL）;groupⅡ,hydroxyethyl starch 130/0.4（HES）;and group Ⅲ,hypertonic sodium chloride hydroxyethy starch 40（HM）.The study was performed under the constant temperature of 37 ℃.Blood samples（10 mL）were obtained from each patients before induction.The in vitro dilution ratios of citrated blood volume to plasma substitute volume were 10∶1,10∶4,10∶10（for RL,HES groups）and 10∶0.5,10∶1,10∶4（for HM group）.Thrombelastograph（TEG）parameters of reaction time（R）,coagulation time（K）,maximum amplitude（MA）,growth angle（α）and other related indices including hematocrit（Hct）and colloid osmotic pressure（COP）were measured.The blood films were also read to observe the changes of cells.Results The R and K values were significantly decreased（P0.05）and α and MA values were increased（P0.01）in group RL at the dilution ratios of 10∶10 compared with those at 10∶4.TEG indices were within the normal range at 10∶1 and 10∶4 in the HES group.When at 10∶10,R and K values were significantly increased and α and MA were significantly decreased（P0.01）.In group HM,the ETG indices were all within the normal range at 10∶0.5 and 10∶1;when at 10∶4,the R and K values were significantly increased（P0.01）and α and MA were significantly decreased（P0.01）compared with those in the rest groups.COP decreased gradually with the increase of hemodilution folds in group RL,but increased in the other two groups.No noticeable morphological changes of blood cells were observed under light microscope.Conc

关 键 词：血栓弹性描记图 离体 血液稀释 凝血 

分 类 号：R614[医药卫生—麻醉学]