琥珀明胶输注量对颅脑手术病人凝血功能的影响  

Gelofusine use impairs blood coagulation in neurosurgery patients

作　　者：王文胜[1] 梁禹[1] 李恒林[1] 

机构地区：[1]天津市环湖医院,天津300060

出　　处：《天津药学》2003年第1期27-29,共3页Tianjin Pharmacy

摘　　要：目的 :研究静脉输注琥珀明胶 (celotusine,血定安 )后对颅脑手术病人凝血功能的影响。方法 :选择 4 6例美国麻醉师协会 (American Society of Anesthesiologists,ASA) ～ 级颅脑手术病人 ,随机分为两组。在异丙酚全麻诱导后 ,第一组病人 (n =2 3)于 6 0分钟内输入血定安 0 .5 L ,第二组病人 (n =2 3)于 6 0分钟内输入血定安 1L。于输注前、输入后 30、6 0、12 0分钟时分别检测病人的血小板计数 (BPC)、红细胞压积 (HCT)、活化部分凝血活酶时间 (APTT)、凝血酶原时间(PT)、纤维蛋白原含量 (Fib )。结果 :血定安 0 .5 L组在输入后 30、 6 0、12 0分钟时对上述各检测项目的影响与输注前相比无明显差异 (P >0 .0 5 )。血定安 1L组在输注后 6 0分钟和 12 0分钟时 BPC、HCT与输液前及输液后 30分钟相比有显著减低 (P <0 .0 5 ) ;血定安 1L组在输液后 6 0分钟和 12 0分钟时 APTT和 PT较输液前及输液后 30分钟明显延长 (P <0 .0 5 ) ;还发现 ,第二组病人的 Fib值在输液后 6 0分钟及 12 0分钟时比输液前及输液后 30分钟有显著降低 (P <0 .0 5 )。结论 :血定安对颅脑手术病人的凝血功能确有一定影响且与输入量呈正相关。血定安 1L组 APTT、 PT的延长和Objective: The aim of this study was to investigate the effect of Gelofusine on blood coagulation in neurosurgery patients. Methods: 46 patients classified as American Society of Anesthesiologists(ASA) physical status Ⅱor Ⅲ undergoing Cerebral operation were randomly assigned to two groups. After induction of general anesthesia with propofol, group Ⅰ (n=23) received Gelofusine 0.5 liters in 60 min, group Ⅱ (n=23) received Gelofusine 1 liter in 60 min. We investigated the BPC, HCT, APTT, PT, Fib before infusion, after infusion 30 min, 60min and 120 min of each group. Results: Gelofusine 0.5 liter had no effect on BPC, HCT, APTT, PT, Fib after infusion 30 min, 60 min and 120 min compared with preinfusion. The 60 min infusion and the 120 min infusion of Gelofusine 1 liter decreased BPC and HCT (P<0.05) compared with 30 min and preinfusion. The 60 min and 120 min infusion of Gelofusine 1L revealed a significant increase of APTT and PT (P<0.05) compared with 30 min and preinfusion. In addition, Fib was decreased during infusion Geiofusine 1L 60 min and 120 min (P<0.05). Conclusion: Our results demonstrated that the administration of a gelatin based plasma substitute (Gelofusine) results in a significant impairment of blood coagulation in neurosurgery patients. The increase in PT, APTT and the decrease in Fib were more than could be expect by calculated plasma dilution generated by Gelofusine. Maybe Gelofusine impairs thrombinogen generation, whereas the decreased thrombin generation may be due to the dilution of coagulation factors induced by Gelofusine. The reason is needed to ascertain in the further.

关 键 词：颅脑手术 血定安 凝血功能 琥珀明胶 凝血酶 血浆代用品 

分 类 号：R977.8[医药卫生—药品] R651.1[医药卫生—药学]