CAJ | 학술논문

目的探讨羟乙基淀粉130/0.4体外不同程度血液稀释对凝血功能的影响.方法采集20名健康志愿者空腹静脉血样,采用6%羟乙基淀粉130/0.4氯化钠注射液作为稀释液,按容量稀释比例(全血∶稀释液)分为6组:10∶0组(未稀释组)、9∶1组(10%组)、8∶2组(20%组)、7∶3组(30%组)、6∶4组(40%组)、5∶5组(50%组).每名志愿者采血23 ml(前3 ml血弃用),其中15 ml用于测定红细胞压积(Hct)、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(AFIT)和纤维蛋白原(Fjb);剩余的5 ml抗凝后,采用血栓弹力描记仪检测血栓弹力描记图(TEG)指标:反应时间(R)、凝血时间(K)、α角和最大振幅(MA).结果 Hct、PLT和Fib随稀释程度的增加而下降(P＜0.05);与未稀释组比较,30%组、40%组和50%组PT和APTT延长,且随稀释程度的增加而延长(P＜0.01).与未稀释组和10%组比较,20%组、30%组和40%组R和K缩短,α角增大,50%组R延长,MA减小(P＜00.05);与20%组、30%组和40%组比较,50%组R和K延长,α角和MA减小(P＜0.05).结论羟乙基淀粉130/0.4体外不同程度血液稀释对凝血功能的影响不同:10%稀释时,对凝血功能无影响;20%～40%稀释时,活化凝血初始阶段,凝血块形成时间缩短,速率增快;50%稀释时,抑制凝血因子活性,凝血块强度降低.
목적 탐토간을기정분130/0.4체외불동정도혈액희석대응혈공능적영향.방법 채집20명건강지원자공복정맥혈양,채용6%간을기정분130/0.4록화납주사액작위희석액,안용량희석비례(전혈∶희석액)분위6조:10∶0조(미희석조)、9∶1조(10%조)、8∶2조(20%조)、7∶3조(30%조)、6∶4조(40%조)、5∶5조(50%조).매명지원자채혈23 ml(전3 ml혈기용),기중15 ml용우측정홍세포압적(Hct)、혈소판계수(PLT)、응혈매원시간(PT)、활화부분응혈활매시간(AFIT)화섬유단백원(Fjb);잉여적5 ml항응후,채용혈전탄력묘기의검측혈전탄력묘기도(TEG)지표:반응시간(R)、응혈시간(K)、α각화최대진폭(MA).결과 Hct、PLT화Fib수희석정도적증가이하강(P＜0.05);여미희석조비교,30%조、40%조화50%조PT화APTT연장,차수희석정도적증가이연장(P＜0.01).여미희석조화10%조비교,20%조、30%조화40%조R화K축단,α각증대,50%조R연장,MA감소(P＜00.05);여20%조、30%조화40%조비교,50%조R화K연장,α각화MA감소(P＜0.05).결론 간을기정분130/0.4체외불동정도혈액희석대응혈공능적영향불동:10%희석시,대응혈공능무영향;20%～40%희석시,활화응혈초시계단,응혈괴형성시간축단,속솔증쾌;50%희석시,억제응혈인자활성,응혈괴강도강저.
Objective To investigate the effects of different degrees of hemedilution with hydroxyethyl starch(HES 130/0.4) on blood coagulation in vitro.Methods Venous blood samplcs obtained from 20 healthyadult volunteers were diluted with HES 130/0.4 into 5 differem degrees of dilufion:10%(blood:HES=9:1),20%(8:2),30%(7:3),40%(6:4) and 50%(5:5).Coagulation of the undiluted and diluted blood was measured using standard coagulation tests and thrombelastography.The variables mead included hematecrit (Hct),platelet count(PLT),plasma fibnogen concentration (Fib),Prothrombin time(PT),activated partial thromboplastin time (APTT),reaction time (R),coagulation time (K),alpha angle (a) and maximal amplitude (MA).Results Hct,PLT and Fib were decreasing with increasing degree of hemedilution.PT and APTT were prolonged in 30%.40% and 50% groups as compared with undiluted control group.R and K were significantly shortened and a angle was sisnificantly increased in 20%.30% and 40% groups while R was significantly,prolonged and MA was decreased in 50% group as compared with undiluted control group and 10% group.R and K were significantly prolonged and a angle and MA were decreased in 50% group as compared with 20%,30% and 40% groups.Conclusion Different degrees of hemodilution with HES 130/0.4 have different effects on blood coagulation in vitro. 10% dilution has no significant effect on blood coagulation.The coagnlability of blood is increased at 20%.30% and 40% dilution.The activities of coagulation factors are depressed and the strength of the blood clot is reduced at 50% dilution.