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羟乙基淀粉高容量血液稀释对脑肿瘤患儿凝血功能及血流动力学的影响
Effect of hypervolemic hemodilution with hydroxyethyl starch 130/0.4 on coagulation and hemodynamic in paediatrics patients undergoing brain tumor surgery
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DOI:
作者:
彭元志
Peng Yuanzhi Du Jianer
作者单位:
上海交通大学医学院附属新华医院麻醉科
Department of Anesthesiology, Xinhua Hospital, Medical School, Shanghai Jiaotong University
关键词:
羟乙基淀粉;血液稀释;血栓弹力图;凝血功能;小儿
Hydroxyethyl starch;Acute hypervolemic hemodilution;Thromboelastography; Coagulation;Paediatrics
摘要:
目的 研究羟乙基淀粉(130/0.4)用于术中高容量血液稀释对脑肿瘤患儿凝血功能及血流动力学的影响。方法 拟择期全麻下行脑肿瘤切除术患儿40例,将其随机分为HES组(羟乙基淀粉)和LR组(乳酸林格氏液),每组20例。两组分别输注HES或LR各15ml/kg进行血液稀释。于扩容前(T0)、扩容后10min(T1)、扩容后1h (T2)及手术结束(T3)抽血检测血栓弹力图的各项指标,并记录各时点血流动力学参数的变化。结果 与T0比较,两组T1时点红细胞压积(HCT)、血红蛋白(Hb)均明显降低,CVP明显升高,差异有统计学意义(P<0.05),组间比较无明显差异。两组患儿MAP与 HR均平稳;两组患儿凝血反应时间(R)、凝血形成时间(K)、血凝块形成速度(α角)与扩容前比较,差异无统计学意义;羟乙基淀粉组最大反应幅度(MA)减少,与扩容前比较差异有统计学意义(P<0.05),手术结束后恢复至术前水平。结论 采用羟乙基淀粉(130/0.4)行扩容治疗能维持血流动力学和凝血功能稳定,推荐剂量的羟乙基淀粉(130/0.4)可安全用于脑肿瘤患儿术中的扩容治疗
Objective To explore the effect of acute hypervolemic hemodilution(AHH) with hydroxyethyl starch 130/0.4(HES) on hemodynamic and coagulation in paediatrics patients undergoing brain tumor surgery. Methods 40 paediatrics patients with brain tumor resection were randomly divided into HES group and LR group(received sodium lactate Ringer's), 20 patients in each group. In the HES group,hydroxyethyl starch 130/0.4 (15mL/kg)was infused for rapid expansion, but only lactate Ringer’S solution was infused in the LR group. Hemodynamic efficacy and thromboelastography(TEG) parameters were recorded before AHH(T0),10 min post-AHH(T1),60 min post-AHH(T2)and at the end of surgery(T3). Results There were no significant differences in MAP, HR, R-time (reaction time to clot formation), K-time (coagulation time) and α angle (rate of clot growth) compared with T0 or between groups. Hct and Hb were significantly lower but higher CVP at T1 and T2 compared with T0, but no significant differences were observed between groups. In the HES group, MA (maximal amplitude)were significantly lower compared with T0 which recovered to preoperative levels after the surgery, but no significant differences were observed between groups. Conclusion There are no negative effects on hemodynamic efficacy and coagulation in paediatrics patients treating with HES 130/0.4, HES preparation can be safely used in intracranial tumor surgery with regard to hemostasis.
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