摘要
目的探讨6%羟乙基淀粉200/0.5(商品名贺斯)与6%羟乙基淀粉130/0.4(商品名万汶)体外不同程度血液稀释对凝血功能的影响。方法采集20名健康志愿者的空腹静脉血23mL,前3mL弃用,每份血样均在体外应用两种羟乙基淀粉进行血液稀释,分为贺斯组和万汶组。每组按容量稀释比例(全血∶稀释液)分为3个稀释度:9∶1(10%)、7∶3(30%)和4∶6(60%)。血样中,15mL用来测定红细胞压积(Hct)、血小板计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(Fib);5mL予枸橼酸化抗凝,血液稀释后在37℃下应用5000Series血栓弹力描记仪检测血栓弹力描记图(TEG)指标:反应时间(R时间,正常值为12～27min)、凝血时间(K时间,正常值为3～13min)、α角(正常值为14～46°)和最大振幅(MA,正常值42～63mm)。TEG图形达到MA后即停止测定。另设1份未稀释的全血作为对照组。结果①贺斯组、万汶组的Hct、血小板计数随稀释程度的增加而进行性下降;30%、60%稀释时,万汶组的血小板计数显著高于贺斯组(P值均<0.05)。②10%稀释时,贺斯组、万汶组的Fib、PT、APTT与对照组的差异均无统计学意义(P值均>0.05);30%稀释时,贺斯组和万汶组的Fib均较对照组显著下降(P值均<0.05),PT、APTT均较对照组显著延长(P值均<0.05),贺斯组与万汶组间Fib、PT、APTT的差异均无统计学意义(P值均>0.05)。③10%稀释时,3组间组R时间、K时间、α角、MA的差异均无统计学意义(P值均>0.05);30%稀释时,贺斯组的R时间、K时间均显著长于万汶组(P值均<0.05),α角、MA均显著小于万汶组(P值均<0.05);60%稀释时,贺斯组的R时间显著长于万汶组(P<0.05),贺斯组与万汶组间α角、MA的差异无统计学意义(P值均>0.05)。结论两种羟乙基淀粉体外不同程度血液稀释对凝血功能的影响不同:10%稀释(轻度血液稀释)时两种羟乙基淀粉对凝血功能无明显影响;30%稀释(中度血液稀释)时6%羟乙基淀粉200/0.5抑制凝血功能,但基本能满足止血要求,6%羟乙基淀粉130/0.4活化凝血初始阶段,凝血块形成时间缩短,速率增快;60%稀释(深度血液稀释)时两种羟乙基淀粉均抑制凝血因子活性,凝血块强度降低。
Objective To investigate the effects of progressive haemodilution of two kinds of hydroxyethyl starch （HES） on blood coagulation in vitro. Methods Venous blood samples obtained from 20 healthy adult volunteers were diluted with HES 130/0.4 and HES 200/0.5 into four different dilution degrees in vitro= undilution （blood：diluent= 10：0）, 10% （9：1）, 30% （7：3） and 60% （4：6）. Coagulation was measured with standard hematological tests and thrombelastography （TEG）. Haematocrit（Hct） ,platelet count （ Pit）, plasma fibrinogen concentration （Fib）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, reaction time （R）,coagulation time （K）, angle α（α） and maximum amplitude （MA） were analyzed. Results Parameters were not affected by 10% dilution （all P〉0.05）. Hot and Pit were decreased with the increase of hemodilution in both groups. Pit in HES 130/0.4 group was significantly higer than that in HES 200/0.5 group at 30% and 60% dilution. Fib was significantly lower while PT and APTT were significantly prolonged at 30% dilution in both groups compared with the values in undilution group （all P〈0.05）. R and K at 30% dilution were significantly prolonged and angle α and MA were significantly lower in HES 200/0.5 group compared those in HES 130/0.4 group. R was significantly longer in HES 200/0.5 group compared to that in HES 130/0.4 group at 60% dilution （P〈0.05）. Conclusion Blood coagulation is not affected by 10% dilution in both HES groups. The coagulation of HES 200/0.5 is inhibited and the rate of initial fibrin formation of HES 130/0.4 is activated at 30% dilution （medium dilution）. The activities of coagulation factors are depressed and the strength of the blood clot is reduced at 60% dilution （profound dilution） in both HES groups.
出处
《上海医学》
CAS
CSCD
北大核心
2009年第1期19-22,共4页
Shanghai Medical Journal
基金
2008年佛山市医学类科技攻关项目(200808049)
