羟乙基淀粉预扩容对髋关节置换术围术期凝血功能的影响  

Effect of pre-infusion Hydroxyethyl Starch on perioperative coagulation function in patients undergoing hit replacement surgery

作　　者：许婷[1] 徐广民[1] 牟玲[1] 蔡兵[1] 范丹[1] 兰志勋[1] 朱谦[2] 

机构地区：[1]四川省医学科学院.四川省人民医院麻醉科,四川成都610072 [2]中日友好医院手术麻醉科,北京100029

出　　处：《四川医学》2011年第12期1849-1851,共3页Sichuan Medical Journal

基　　金：2009年四川省卫生厅科研课题(编号:090513)

摘　　要：目的用血栓弹力图(TEG)检测羟乙基淀粉预扩容在全髋关节置换患者术中对凝血功能的影响,为围术期采用合理的液体治疗方法提供依据。方法 40例股骨颈骨折需行髋关节置换术的老年患者(ASAⅡ～Ⅲ级),随机分为实验组(G1)和对照组(G2),实验组在手术开始前给予羟乙基淀粉20ml/kg行预扩容。对照组在手术开始前给予乳酸林格钠氏液20ml/kg。分别在预扩容输液前(T0)、预扩容输液后60min(T1)、关节置换后2h(T2)采集静脉血测定凝血系列用血栓弹力描记仪测定R、K、MA、CI。结果实验组在T1时间,与T0相比R和K,以及PT和APTT均延长(P<0.05)。对照组完成关节置换后2h较术前比较,R和K,以及PT和APTT均缩短(P<0.05);实验组在T2时间点R和K以及PT和APTT均显著延长(P<0.05),但是实验组在T1,T2时刻测得的TEG参数以及PT与APTT均在正常范围内。结论股骨颈骨折行髋关节置换术患者术前、术中及术后血液呈不同程度高凝状态。在全髋关节置换患者手术过程中采用羟乙基淀粉预扩容虽然对凝血功能有影响使P,K,PT,APTT均延长,但在正常范围内,能减轻患者高凝状态,没有不良反应。可以安全应用。Objective Using thromboelaslography （TEG） to assessment perioperative coagulation function of pre-infusion Hydroxyethyl Starch in patients undergoing hit replacement. Methods Forty gerontal patients （ ASA Ⅱ～Ⅲ） were randomly divided into two groups, the study group （G1 group） and the control group （G 2 group）. Before operation, the G1 group were administered with 20ml/kg Hydroxyethyl Starch.. the G2 group were administered with 20ml/kg lactated Ringer＇s fluid. The venous blood were collected for coagulation function test at the following time points ： at the beginning of pre-infusion Hydroxyethyl Starch （To ）, 60minitues after Hydroxyethyl Starch pre-infusion（Tl）and two hours after the hit replacement（ T2 ）. Thromboelaslographic parameters such as R, K, MA and C1 variables were measured at To, T^and T2. Ttle PT and AFFF were recorded, either. Results The parameters P,K,PT and AFFF in study group at T1 time point were increased, ~4th significant differeces compared to TO time point, P 〈 0. 05. The parameters P, K, PT and AFIT in control group at T2 time point were significantly decreased compared to T0 time point, P 〈0. 05. The paraaleters P,K,PT and APTT at T2 time point in study group were significantly increased compared with control group, P 〈 0.05. All parameters variables in study group were in normal range. Conclusion Pre-infusion of Hydroxyethyl Starch can prolong the P, K, PT and APTT in normal range and alleviate the high coagulatant state of patients undergoing hit replacement but has no adverse effect on coagulation function.

关 键 词：血栓弹力图 预扩容 羟乙基淀粉 凝血功能 髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]