急性高容量血液稀释对结肠癌患者血小板活化的影响  

Effect of acute hypervolemic hemodilution on platelet activation in patients undergoing colon cancer surgery

作　　者：单汉民[1] 王钱荣[1] 高斌[1] 何焕钟[1] 祁涛 SHAN Hanmin;WANG Qianrong;GAO Bin(Department of Anesthesiology,Huzhou Central Hospital,Huzhou 313000,CHINA)

机构地区：[1]湖州市中心医院麻醉科,浙江313000 [2]南京医科大学第一附属医院麻醉与围术期医学科

出　　处：《江苏医药》2019年第11期1096-1099,1104,共5页Jiangsu Medical Journal

基　　金：湖州市科技局公益性应用研究项目(2016GYB46)

摘　　要：目的探讨急性高容量血液稀释(AHH)对结肠癌患者全身麻醉下行结肠癌根治术血小板活化等指标的影响。方法行结肠癌根治术患者45例随机均分为A、B和C三组,麻醉诱导后经颈内静脉以15 ml/kg的剂量和30 ml·kg^-1·h^-1速率分别输注复方乳酸钠、羟乙基淀粉200/0.5(HES200/0.5)和HES130/0.4溶液。分别在AHH前即刻(T0)、AHH后即刻(T1)、AHH后1 h(T2)和3 h(T3)检测CD62p、CD63、凝血酶原时间(PT)、APTT和血小板,记录AHH期间HR和MAP变化。结果B组T2时CD62p水平低于T0、T1时(P<0.05),T3时CD62p水平低于T0时(P<0.05);B组T1~T3时CD62p水平均低于A组和C组(P<0.05)。B组T1、T2时CD63水平低于C组(P<0.05);A组T1时CD63水平较T0时升高(P<0.05),B组T2时CD63水平较T0、T1时均降低(P<0.05)。结论结肠癌患者存在血小板过度活化现象;围手术期应用HES200/0.5行AHH可降低CD62p及CD63表达,有效抑制血小板过度活化,从而降低围手术期肿瘤血行转移的潜在风险。Objective To investigate the effect of acute hypervolemic hemodilution(AHH)on the platelet activation in the patients undergoing radical colon cancer surgery under general anesthesia.Methods AHH was performed in 45 patients undergoing radical colon cancer surgery,who were infused with lactated Ringer's solution(group A,15 cases),hetastarch solution HES 200/0.5(group B,15 cases)or HES 130/0.4(group C,15 cases)in a dose of 15 ml/kg and a speed of 30 ml·kg^-1·h^-1.The blood samples were taken to detect the levels of CD62p,CD63,PT,APTT and platelet at the time points of immediately before AHH(T0),immediately after the end of AHH(T1),one hour(T2)and 3 hours(T3)after AHH.The changes of HR and MAP during AHH were recorded as well.Results In group B,CD62p was lower at T2 than that at T0 and T1(P<0.05),which was lower at T3 than that at T0(P<0.05).CD62p at T1-T3 was lower in group B than that in groups of A and C(P<0.05).CD63 at T1 and T2 was lower in group B than that in group C(P<0.05).CD63 of group A was higher at T1 than that at T0(P<0.05).CD63 of group B was lower at T2 than that at T0 and T1(P<0.05).Conclusion There is an excessive platelet activation in the patients with colon cancer.Perioperative AHH with HES 200/0.5 can reduce the expressions of CD62p and CD63,effectively inhibit the excessive activation of platelets,and reduce the potential risk of perioperative tumor hematogenous metastasis.

关 键 词：急性高容量血液稀释 结肠癌 血小板活化 

分 类 号：R614[医药卫生—麻醉学]