CAJ | 학술논문

目的评价羟乙基淀粉130/0.4(HES 130/0.4)与羟乙基淀粉200/0.5(HES 200/0.5)急性高容量血液稀释(AHH)对大面积烧伤患者围术期凝血功能的影响.方法拟行早期切痂术的大面积烧伤患者40例,年龄18～49岁,ASAⅡ级,随机分为HES 200/0.5组(HES 200组)与HES 130/0.4组(HES 130组),每组20例,另选20名健康志愿者为正常对照组(C组).麻醉诱导开始时HES 200组和HES 130组经30 min分别静脉输注HES 200/0.5、HES 130/0.4 15 ml/kg,行AHH,C组不予任何处理.于麻醉诱导前(T0)、AHH结束即刻(T1)、AHH后1 h(T2)、术后1 h(T3)时采用流式细胞仪检测血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)、CD62P的表达水平,采用血栓弹力图描记仪测定以下指标:反应时间(R).凝血时间(K)、α角、最大振幅(MA)和凝血指数(CI).结果与C组比较,HES 200组和HES 130组血小板GPⅡb/Ⅲa、CD62P表达上调,R、K缩短,α角、MA、CI增大(P<0.05);与HES 200组比较,HES 130组血小板GPⅡb/Ⅲa、CD62P表达上调,R缩短,α角、MA和CI增大(P<0.05);与T0时比较,HES 200组AHH后血小板GPⅡb/Ⅲa、CD62P表达下调,R、K延长,α角、MA、CI减小(P<0.05),HES 130组R、K延长,α角、CI减小(P<0.05),MA和血小板GPⅡb/Ⅲa、CD62P差异无统计学意义(P>0.05).结论 HES 200/0.5 AHH可抑制大面积烧伤患者围术期血小板过度活化,其减轻血液高凝状态的效应强于HES 130/0.4.
목적 평개간을기정분130/0.4(HES 130/0.4)여간을기정분200/0.5(HES 200/0.5)급성고용량혈액희석(AHH)대대면적소상환자위술기응혈공능적영향.방법 의행조기절가술적대면적소상환자40례,년령18～49세,ASAⅡ급,수궤분위HES 200/0.5조(HES 200조)여HES 130/0.4조(HES 130조),매조20례,령선20명건강지원자위정상대조조(C조).마취유도개시시HES 200조화HES 130조경30 min분별정맥수주HES 200/0.5、HES 130/0.4 15 ml/kg,행AHH,C조불여임하처리.우마취유도전(T0)、AHH결속즉각(T1)、AHH후1 h(T2)、술후1 h(T3)시채용류식세포의검측혈소판막당단백Ⅱb/Ⅲa(GPⅡb/Ⅲa)、CD62P적표체수평,채용혈전탄력도묘기의측정이하지표:반응시간(R).응혈시간(K)、α각、최대진폭(MA)화응혈지수(CI).결과 여C조비교,HES 200조화HES 130조혈소판GPⅡb/Ⅲa、CD62P표체상조,R、K축단,α각、MA、CI증대(P<0.05);여HES 200조비교,HES 130조혈소판GPⅡb/Ⅲa、CD62P표체상조,R축단,α각、MA화CI증대(P<0.05);여T0시비교,HES 200조AHH후혈소판GPⅡb/Ⅲa、CD62P표체하조,R、K연장,α각、MA、CI감소(P<0.05),HES 130조R、K연장,α각、CI감소(P<0.05),MA화혈소판GPⅡb/Ⅲa、CD62P차이무통계학의의(P>0.05).결론 HES 200/0.5 AHH가억제대면적소상환자위술기혈소판과도활화,기감경혈액고응상태적효응강우HES 130/0.4.
Objective To evaluate the effects of acute hypcrvolemic hemodilution (AHH) with hydroxyethyl starch (HES) 200/0.5 or 130/0.4 on coagulation function in patients with large-area burn injury during perioperative period. Methods Forty ASA Ⅱ patients aged 18-49 yr undergoing early eschar excision surgery were randomly divided into 2 groups (n = 20 each): HES 200/0.5 group (group HES 200) and HES 130/0.4 group (group HES 130). Twenty health volunteers were selected as normal control group (group C). In groups HES 200 and HES 130, HES 15 ml/kg was infused over 30 min at the beginning of induction of anesthesia. Flow cytometry was used to detect the expression of GPⅡb/Ⅲa and CD62P before induction of anesthesia (baseline,T0), immediately after the end of AHH (T1), at 1 h after the end of AHH (T2) and at 1 h after the end of surgery (T3). Thrombelastography (TEG) was used to detect the reaction time (R), clotting time (K), α angle, maximum amplitude (MA) and coagulation index (CI). Results The expression of GPⅡb/Ⅲa and CD62P was up-regulated, R and K were shortened, and α angle, MA and CI were increased in group HES 200 and HES 130 compared with group G (P<0.05). The expression of GPⅡb/Ⅲa and CD62P was up-regulated, R was shortened, and α angle, MA and CI were increased in group HES 130 compared with group HES 200 (P<0.05) . The expression of GPⅡb/Ⅲa and CD62P was down-regulated, R and K were prolonged, and α angle and CI were decreased in group tIES 200 (P<0.05), and R and K were prolonged, and α angle and CI were decreased in group HES 130 as compared to the baseline values at T0(P<0.05). Conclusion AHH with HES 200/0.5 can alleviate hypercoagulable state through inhibitting excessive platelet activation during perioperative period in patients with large-area burn and HES 200/0.5 is better than HES 130/0.4.