CAJ | 학술논문

目的评价羟乙基淀粉130/0.4电解质注射液等容血液稀释对老年患者肝肿瘤切除术中凝血功能的影响.方法拟在全麻下行择期肝肿瘤切除术老年患者40例,ASA分级Ⅱ级,年龄65 ～ 74岁,按照随机数字表法分为2组(n=20):对照组(C组)和等容血液稀释组(NH组).NH组在麻醉诱导后静脉输注6％羟乙基淀粉130/0.4电解质注射液行等容血液稀释,C组行常规容量管理.于麻醉诱导前(T1)、等容血液稀释后30 min(T2)、手术1 h(T3)和术毕(T4)时采集静脉血样,测定凝血功能常规指标、可溶性纤维蛋白单体复合物(SFMC)及血小板膜糖蛋白(PAC-1)的水平.结果与C组比较,NH组术中出血量、凝血酶原时间、活化部分凝血活酶时间、SFMC及PAC-1的水平差异无统计学意义(P＞0.05),术中异体输血量减少,T2-4时纤维蛋白原浓度下降(P＜0.05);与T1比较,T2-4时NH组纤维蛋白原浓度下降,2组凝血酶原时间和活化部分凝血活酶时间延长(P＜0.05),但仍在正常范围,而其他指标差异无统计学意义(P＞0.05).结论羟乙基淀粉130/0.4电解质注射液等容血液稀释对老年患者肝肿瘤切除术中凝血功能无明显影响,且具有一定的血液保护作用.
목적 평개간을기정분130/0.4전해질주사액등용혈액희석대노년환자간종류절제술중응혈공능적영향.방법 의재전마하행택기간종류절제술노년환자40례,ASA분급Ⅱ급,년령65 ～ 74세,안조수궤수자표법분위2조(n=20):대조조(C조)화등용혈액희석조(NH조).NH조재마취유도후정맥수주6％간을기정분130/0.4전해질주사액행등용혈액희석,C조행상규용량관리.우마취유도전(T1)、등용혈액희석후30 min(T2)、수술1 h(T3)화술필(T4)시채집정맥혈양,측정응혈공능상규지표、가용성섬유단백단체복합물(SFMC)급혈소판막당단백(PAC-1)적수평.결과 여C조비교,NH조술중출혈량、응혈매원시간、활화부분응혈활매시간、SFMC급PAC-1적수평차이무통계학의의(P＞0.05),술중이체수혈량감소,T2-4시섬유단백원농도하강(P＜0.05);여T1비교,T2-4시NH조섬유단백원농도하강,2조응혈매원시간화활화부분응혈활매시간연장(P＜0.05),단잉재정상범위,이기타지표차이무통계학의의(P＞0.05).결론 간을기정분130/0.4전해질주사액등용혈액희석대노년환자간종류절제술중응혈공능무명현영향,차구유일정적혈액보호작용.
Objective To evaluate the effects of normovolemic hemodilution (NH) with hetastarch starch 130/0.4 and electrolyte solution on blood coagulation during resection for liver cancer in the elderly patients.Methods Forty patients,of ASA physical status Ⅱ,aged 65-74 yr,scheduled for elective resection for liver cancer under general anesthesia,were randomly divided into NH group (n =20) and control group (group C,n =20).NH group underwent NH with 6％ hematocrit starch 130/0.4 and electrolyte solution after induction of anesthesia,while group C underwent routine fluid management.Before induction of anesthesia (T1),at 30 min after NH (T2),at 1 h during operation (T3),and at the end of operation (T4),venous blood samples were collected for measurement of the routine parameters of blood coagulation,and levels of soluble fibrin monomer complex (SFMC),and platelet membrane glycoprotein (PAC-1,platelet activation marker).Results Compared with group C,no significant changes were found in intraoperative blood loss,PT,APTT,and levels of SFMC and PAC-1,the volume of allogeneic blood transfused was reduced,and Fib was decreased at T2-4 in NH group.Compared with the baseline value at T1,Fib was decreased significantly at T2-4 in NH group,and PT and APTT were prolonged but still within the normal range,and no significant changes were found in the other parameters in both groups.Conclusion NH with hetastarch starch 130/0.4 and electrolyte solution exerts no effect on blood coagulation during resection for liver cancer and provides blood-saving effect to some extent in the elderly patients.