临床常用人工血浆代用品离体血液稀释对凝血功能的影响  

Effects of hemodilution with different artificial plasma substitutes on blood coagulation in vitro

作　　者：邓小明[1] 李金宝[1] 邓彩英[1] 朱科明[1] 李永庆[1] 

机构地区：[1]第二军医大学附属长海医院麻醉科,上海200433

出　　处：《中华麻醉学杂志》2003年第6期447-450,共4页Chinese Journal of Anesthesiology

摘　　要：目的 探讨人工血浆代用品进行离体不同程度血液稀释对凝血功能的影响。方法采取10名成年男性健康志愿者静脉血在离体状态下按不同液体分组分别用10％羟已基淀粉(HES)、琥珀酰明胶(血定安)及聚明胶肽(海脉素)进行33％、50％、66％稀释,并以未稀释的全血作为基础值。血样本用Sonoclot凝血和血小板功能分析仪(sonoclot分析仪)进行动态的凝血功能检测,包括凝结时间(sonACT)、凝结速率及血小板功能(PF);同时采用常规实验室方法检测血细胞比容(Hct)、血小板计数(Plt)、活化部分凝血活酶时间(APTF)以及纤维蛋白原(Fig)含量。结果 Sonoclot分析仪检测显示33％稀释后sonACT均显著缩短(P<0.05),50％及66％稀释时平衡液、海脉素、血定安三组sonACT仍比基础值显著缩短,而HES组66％稀释时显著延长(P<0.01);33％稀释时HES组凝结速率较基础值显著降低,平衡液、海脉素、血定安三组无明显变化;50％及66％稀释时,各组凝结速率均显著降低,以海脉素组降低幅度最小(P<0.01);33％稀释时血定安组PF显著降低(P<0.01),50％及66％稀释时HES组和血定安组显著降低(P<0.01),而平衡液和海脉素组无明显变化。常规实验室检测显示Hct、Plt、Fig均随稀释程度加重进行性降低,APTT随稀释程度加重进行性延长。结论Objective To investigate the effects of different degrees of hemodilution with the artificial plasma substitutes most commonly used in clinical practice on coagulation in vitro. Methods Ten male ASA physical status I volunteers aged (28.8±1.6) yr and weighing (66±8) kg were enrolled. Venous blood samples obtained from each volunteer were diluted with 10% HES (200 000/0.4-0.55), 4 % succinylated gelatin (gelofusine GEL), 3.5 % polygeline (Haemaccel HAE) and lactated Ringer's solution (RL) by 33% [blood: diluent(B:D) =2:1], 50% (B:D=1:1) and 66% (B:D=1:2). Coagulation of the undiluted blood (control) and diluted blood was measured with sonoclot coagulation and platelet function analyzer (SCT) and by routine coagulation tests. The parameters measured included activated clotting time (ACT), clot rate, platelet function (PF), Hct, platelet count (Pit), plasma fibrinogen concentration (Fig) and activated partial thromboplastin time (APTT) . Results (1) At 33 % dilution ACT was significantly shortened in all the four groups as compared with control value; at 50 % dilution ACT was significantly shorter than the control in RL, HES and HAE groups; at 66 % dilution ACT was significantly prolonged in HES group. (2) Clot rate was significantly decreased at 33 % dilution only in HES group but was significantly decreased in all the four groups at 50 % and 66 % dilution. (3) PF decreased significantly only in GEL group at 33 % dilution but was significantly decreased in GEL and HES groups at 50 % and 66 % dilution. (4) With increasing dilution Hct, Pit and Fig gradually decreased and APTT was prolonged. Conclusion Coagulation changes are closely related to the degrees of dilution. At 33 % dilution, the three artificial plasma substitutes tested do not significantly affect hemostasis. At 50 % and 66 % dilution coagulation is badly impaired, but there are differences among the substitutes used for dilution. HAE impairs oagulation least as it contains higher calcium

关 键 词：人工血浆代用品 血液稀释 凝血功能 羟已基淀粉 琥珀酰明胶 聚明胶肽 

分 类 号：R96[医药卫生—药理学]