晶胶比1∶1急性高容量血液稀释法对凝血功能的影响  

The effect of acute hypervolemic hemodilution with Ratio of crystal tocolloidwith 1:1on blood coagulation

作　　者：曹兴华[1] 贺杰 刘松涛[1] CAO Xing-hua;HE Jie;LIU Song-tao(The affiliated Chinese traditional medicine hospital of Xinjiang Medical University,Urumqi,830099,China)

机构地区：[1]新疆医科大学附属中医医院,乌鲁木齐830099

出　　处：《新疆医学》2021年第11期1250-1252,共3页Xinjiang Medical Journal

基　　金：新疆维吾尔自治区自然科学基金(项目编号:2017D01C152)。

摘　　要：目的评价按照1∶1比例混合羟乳酸钠林格液与乙基淀粉130/0.4氯化钠注射液实施急性高容量血液稀释(Acute hypervolemic hemodilution,AHH)对手术患者凝血功能的影响。方法纳入在全身麻醉下行脊柱手术的患者56例,年龄18-59岁,BMI 18-26 kg/m^(2),ASAⅠ-Ⅱ。入室后输入乳酸钠林格液按照10 mL/kg,麻醉诱导插管后按照15 mL/kg快速输注晶胶体比例为1∶1的混合液。分别于AHH前(T0)、AHH后30 min(T_(1))、术后第1d(T_(2))测凝血功能和快速血栓弹力图(Thromboelastography,TEG)。监测并记录HR、MAP、CVP、尿量、输血量、出血量、总输液量。结果与AHH前比较,AHH后30 min Hct、Hb明显降低,差异有统计学意义(P<0.05),术后第1d与AHH前相比差异无统计学意义(P>0.05);TEG中R值在扩容后30 min较扩容前明显延长,与AHH前相比差异有统计学意义(P<0.05),其余指标在扩容后30 min、术后第1d与扩容前相比差异无统计学意义(P>0.05)。结论羟乙基淀粉130/0.4氯化钠注射液与乳酸钠林格液按照1∶1实施急性高容性血液稀释对患者的R值有短时间的影响,可安全用于患者围术期的血液保护。Objective To evaluate the effect of acute hypervolemichemodilutiontherapy with 1∶1 mixture of sodium hydroxylactateringer solution and ethyl starch 130/0.4 sodium chloride injection on blood coagulation function of surgical patients.Methods Forty-six patients,aged from 18 to 59 years,with BMI 18-26 kg/m^(2) and ASAⅠ~Ⅱwere selected for spinal surgery under elective general anesthesia.All patientswere treated with 10 m L/kg sodium lactate ringer’s solution to supply the amount of fluid.After anesthesia induction and intubation,the mixed solution with ratio of crystal to colloid with 1∶1 was infused rapidly according to amount of 15 ml/kg.Before AHH(T0),30 minutes after AHH(T_(1))and the first day after surgery(T_(2)),the parameters of common coagulation function and rapid thrombelastography(TEG)were measured.HR,MAP,CVP,the volume of urine,blood transfusion,blood loss,total infusion volume,and operation time were recorded during the operation.Results The levels of Hct and Hb were more significantly decreased at 30 minutes after AHH than those before AHH(P<0.05),but there were no significant differencesbetween the levels of Hct and Hb at the first day after the operation and those before AHH(P>0.05).The R value of each parameter of TEG in each period was significantly longer than that before the expansion(P<0.05).The other parameters including K value,MA,and angle had no differences between the level at 30 minutes after the expansionand those before the expansion(P>0.05).Conclusions Acute hypervolemichemodilution with 1∶1 hydroxyethyl starch 130/0.4 sodium chloride injection and sodium lactate ringer solution has a short-term effect on the R value of patients,which can be safely used for perioperative blood protection.

关 键 词：急性高容量血液稀释 血栓弹力图 血液保护 

分 类 号：R614[医药卫生—麻醉学]