血栓弹力图检测羟乙基淀粉对非体外循环冠状动脉旁路移植术后凝血功能的影响  

Influence of Hydroxyethyl Starch on Blood Coagulation of Patients after Off-pump Coronary Artery Bypass Grafting by Thromboelastography

作　　者：孟庆涛[1] 王辉山[1] 韩宏光[1] 韩劲松[1] 李晓密[1] 陈朝辉[1] 芦勤[2] 

机构地区：[1]沈阳军区总医院心血管外科,沈阳110016 [2]沈阳军区总医院心血管内科,沈阳110016

出　　处：《中国胸心血管外科临床杂志》2014年第6期753-757,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：辽宁省科学技术计划项目(2012225005)~~

摘　　要：目的探讨血栓弹力图（thromboelastography，TEG）检测非体外循环冠状动脉旁路移植术后输注6％羟乙基淀粉130／0．4对患者凝血功能的影响。方法选取2013年5～7月沈阳军区总医院心血管外科ICU收治的择期非体外循环冠状动脉旁路移植术患者100例，按随机数字表法将患者分为两组，每组50例。试验组（G1组）：男27例、女23例，年龄（64．9±4．4）岁，术后4h内输入6％羟乙基淀粉130／0．4注射液（20ml／kg）；对照组（G2组）：男3l例、女19例，年龄（63．1±5．8）岁，术后4h内输入平衡液（20ml／kg）。术后返回监护室行血常规、常规凝血及血栓弹力图检查，术后6h、24h记录胸腔、纵隔引流量。结果术后24hG1组和G2组的胸腔、纵隔引流量差异无统计学意义[（591．7±171．7）mlvs．（542．4±174．0）ml，P〉0．05]，均无二次开胸止血者。两组间血红蛋白、红细胞压积、血小板数量无明显变化（P〉0．05）；传统凝血监测指标无明显变化。血栓弹力图检测发现，给予输液扩容后，两组的凝血酶形成时间（coagulation time，K）无明显变化，G1组和G2组的反应时间（reactiontime，R）均略延长，但差异无统计学意义（P〉0．05）。G1组扩容后最大振幅（maximum amplitud，MA）降低，但仍在正常范围内，与扩容前差异有统计学意义[（55．9±10．0）mmvs．（62．8±7．9）mm，P〈0．05]，G2组扩容后MA无明显变化。结论输注6％羟乙基淀粉130／0．4注射液（20ml／kg）影响血小板功能，降低血栓形成的强度，但对术后胸腔和纵隔引流量无明显影响，不增加开胸止血例数，应用于非体外循环冠状动脉旁路移植术后患者是安全的。Objective To investigate the influence of 6% hydroxyethyl starch （HES, 130/0.4） on blood coagulation of patients after off-pump coronary artery bypass grafting （OPCAB） by thromboelastography （TEG）. Methods One hundred patients undergoing elective OPCAB in Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command between May and July 2013 were enrolled in this study. All the patients were randomly divided into 2 groups using random number table method with 50 patients in each group. In the experimental group （G1 group ）, there were 27 males and 23 females with their age of 64.9± 4.4 years, who received intravenous 6% HES （130/0.4） 20 ml/kg in 4 hours postoperatively. In the control group （G2 group）, there were 31 males and 19 females with their age of 63.1± 5.8 years, who received intravenous lactated ringers 20 ml/kg in 4 hours postoperatively. After postoperative ICU admission, full blood count, coagulation tests and TEG were examined. Chest and mediastinal drainage was recorded at 6 hours and 24 hours postoperatively. Results There was no statistical difference in chest and mediastinal drainage 24 hours postoperatively between the 2 groups （591.7± 171.7 ml vs. 542.4±174.0 ml, P 〉 0.05）. None of the patients received reexploration for bleeding. There was no statistical difference in hemoglobin, hematocrit, platelet count or traditional coagulation index be- tween the 2 groups （P 〉 0.05）. TEG showed no significant change in coagulation time after intravenous fluid infusion in either group. Reaction time was slightly extended in both groups, but there was no statistical difference in reaction time between the 2 groups （P 〉 0.05）. Maximum amplitude （MA） of G1 group was significantly decreased after intravenous fluid infusion （55.9±10.0 mm vs. 62.8＋7.9 ram, P 〈 0.05）, but still within the normal range. There was no significant change in MA after intravenous fluid infusion in G2 group. Conclusion Intravenous infusion of 6% HES �

关 键 词：羟乙基淀粉 血栓弹力图 凝血 非体外循环冠状动脉旁路移植术 围术期 

分 类 号：R654.2[医药卫生—外科学]