体外循环常用预充液离体血液稀释对凝血功能的影响

摘要

[ Abstract]:Objective To compare the effects of in vitro hemodilution with lactated Ringer's solution, hydroxyethyl starch 130/0.4 and 4% succinyl gelatin on the blood coagulation function. Methods Blood was taken from 10 healthy young male volunteers. Blood was diluted by 10%, 30%, and 50% using either 6% hydroxyethyl starch 130/0.4 ( Group W) , 4% succinyl gelatin ( Group G) and Ringer's lactate solution ( Group L) . Thrombelastograph ( TEG) was performed and record reaction time ( R time) , blood clotting time ( K time) , alpha angle, maximum amplitude ( MA) , at the same time conventional coagulation parameters were detected, such as hemoglobin( Hb) , prothrombin time ( PT) , prothrombin time activity ( PTA) , international normalized ratio ( INR) , partial thrombo⁃plastin time ( APTT) , thrombin time ( TT) and fibrinogen ( FIB) . Results R time was shortened and MA was increased in L group at 10% dilution ( P<0.05) . Negative effects on the coagulation system were shown in the Group G and Group W at 30% dilution ( P<0.05) , but most coagulation parameters were in the normal range. The coagulation function were impaired in all group at 50% dilution ( P<0.05) . Conclusion Coagulation function was closely related to the degrees of dilution. At 10% dilution, the three fluids do not significantly affect hemostasis.At 30% dilution, hydroxyethyl starch 130/0.4 and gelatin impaired the coagulation system, but the whole coagulation function was intact. At 50% dilution, the hemostasis was impaired greatly in all groups.%目的探讨体外循环常用预充液离体条件下进行不同程度血液稀释后对凝血功能的影响。方法采取10名成年男性健康志愿者静脉血，分别用乳酸林格氏液（L组），4％琥珀酰明胶（G组）及和6％羟乙基淀粉130／0．4（W组），进行10％、30％、50％的稀释，以未稀释血作为基础值。用血栓弹力图（ TEG）行动态凝血功能检测，包括反应时间（ R）、血凝块时间（ K）、凝固角（α角）、血凝块强度值最大振幅（ MA）；同时用常规实验室方法检测血细胞比容（ Hct）、血小板计数（ Plt）、凝血酶原时间（ PT）、凝血酶原时间活动度（ PTA）、国际标准比值（ INR）、部分凝血活酶时间测定（ APTT）、凝血酶时间（ TT）及纤维蛋白原（ FIB）含量。结果常规实验室检查表明Hct、Plt、FIB随稀释程度增加而降低，与基础值比较，10％稀释时，L组TT值显著缩短（ P＜0．05），稀释30％和50％时，各组PT、APTT、INR均显著延长（ P＜0．01）。 TEG结果显示值比较，10％稀释后L组的K值显著缩短（ P＜0．05），MA增大（ P＜0．05）；30％稀释时，G组和W组多项参数有显著变化（ P＜0．05），但大多仍处于正常范围；50％稀释时，各组所有凝血参数均有显著变化（ P＜0．05），且大多超出正常范围。结论不同预充液体血液稀释后对凝血功能的影响程度不一，L组10％稀释时凝血功能略有增强；30％稀释时对凝血指标没有影响，G组和W组在30％稀释时对部分凝血参数有影响，但整体凝血功能仍处于正常范围，50％稀释时各组凝血功能均显著下降。