6％羟乙基淀粉200／0．5氯化钠注射液对外科手术围术期凝血功能和肾功能的影响  

Effects of 6 % hydroxyethyl starch 200/0.5 on blood coagulation and renal function during periop- erative period

作　　者：郭崇勇[1] 王建丰[1] 

机构地区：[1]上海交通大学附属第一人民医院普外科,200080

出　　处：《临床外科杂志》2012年第8期560-562,共3页Journal of Clinical Surgery

摘　　要：目的探讨围手术期应用6％羟乙基淀粉（Hetastarch，HES）200／0．5氯化钠注射液对外科手术中全麻患者凝血功能及肾功能的影响。方法限期全麻胃肠道恶性肿瘤手术患者40例，随机分为两组，每组20例：6％HES130／0．4（A组，万汶）和6％HES200／0．5（B组，代斯）。根据晶胶结合（2：1）的原则补液，全麻术中输实验药物1000ml，术后第1、2天输实验药物量为1000ml／d。术前和术后第3天检测以下指标：血红蛋白（Hb）、血细胞比容（Hct）、血尿素氮（BUN）、血清肌酐（SCr）、凝血酶原时间（PT）、凝血酶时间（TT）、部分凝血活酶时间（APTT）、vonWillebrand（vWF）因子活性、Ⅷ因子活性、全血黏度高切变率、全血黏度低切变率、血浆黏度。结果术后两组患者Hb、Hct均下降，但组间差异无统计学意义（P〉0．05）。术后两组患者SCr均明显下降，组间、组内差异均有统计学意义（P〈0．05），但均在正常范围。两组患者盯、TT、APTT、全血黏度高切变率、血浆黏度、vWF因子活性、Ⅷ因子活性、BUN术前术后改变组间、组内差异无统计学意义（P〉0．05）。结论6％羟乙基淀粉200／0．5氯化钠注射液进行容量替代治疗时对外科手术全麻患者凝血功能及肾功能的影响较小。Objective To investigate the effects of 6% hydroxyethyl starch （Hetastarch, HES ） 200/0.5 on blood coagulation and renal function in patients receiving general anaesthesia. Methods For- ty patients with ASA Ⅱ , aged 18 -70 years, undergoing a limited gastrointestinal cancer operation with general anaesthesia,were randomly divided into two groups,including 6% HES 130/0.4 group （group A, Voluven,20 eases）and 6% HES 200/0.5（group B, Daisi,20 cases）. According to the principle of fluid infusion, the ratio of crystalloids to colloids was classically described as 3：1. Each patient received 1000ml infusion during the surgery,then another 1000 ml infusion was infused on the 1st and 2nd day after surger- y. Venous blood samples were obtained before operation and on the 3rd day after operation for measurement of hemoglobin（ HB ）, hematocrit （ Hct ）, blood urea nitrogen （ BUN ）, serum creatinine （ SCr ）, prothrombin time （ PT）, thrombin time （ Tr）, activated partial thromboplastin （ AFFF）, yon willebrand factor （vWF） fac- tor,coagulation factor Ⅷ activity,whole blood viscosity（WBV） at low or high shear rates and plasma vis- cosity. Results The level of Hb and HCT decreased after surgery, but there was no significant difference between the two groups. The level of SCr significantly decreased after operation. Significant intragroup and intergroup differences were observed while all were within the normal range. There was no significant intra- group or intergroup difference in PT, TF, APTT, WBV, plasma viscosity, vWF activity, coagulation factor Ⅷ activity and BUN（P 〉 0.05）. Conclusion 6% hydroxyethyl starch 200/0.5 can be safely used for plasma volume replacement, which has no significant effect on blood coagulation system or renal function in surgical patients.

关 键 词：羟乙基淀粉 肾功能 血液凝固实验 

分 类 号：R619.9[医药卫生—外科学]