中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (17): 3067-3070.doi: 10.3969/j.issn.1673-8225.2011.17.008

• 人工假体 artificial prosthesis • 上一篇    下一篇

小剂量高渗氯化钠羟乙基淀粉40预扩容对全髋关节置换中凝血功能的影响

司建洛，宋绍团   

  1. 河南科技大学第一附属医院麻醉科，河南省洛阳市    471003
  • 收稿日期:2010-11-13 修回日期:2011-01-24 出版日期:2011-04-23 发布日期:2011-04-23
  • 作者简介:司建洛★，男，1972年生，河南省洛阳市人，汉族，2004年首都医科大学毕业，硕士，主治医师，主要从事围术期器官保护的研究。 jianluo_si@sina.com

Effects of small dose hypertonic sodium chloride hydroxylethy starch 40 preloading on coagulation function during total hip arthroplasty 

Si Jian-luo, Song Shao-tuan   

  1. Department of Anesthesiology, First Affiliated Hospital, Henan University of Science and Technology, Luoyang  471003, Henan Province, China
  • Received:2010-11-13 Revised:2011-01-24 Online:2011-04-23 Published:2011-04-23
  • About author:Si Jian-luo★, Master, Attending physician, Department of Anesthesiology, First Affiliated Hospital, Henan University of Science and Technology, Luoyang 471003, Henan Province, China jianluo_si@sina.com

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518

被引次数

7

摘要：

背景：髋关节置换前应用小剂量高渗氯化钠羟乙基淀粉40预扩容对患者凝血功能的影响缺乏系统性研究。
目的：对比观察小剂量高渗氯化钠羟乙基淀粉40与琥珀酰明胶预扩容影响全髋关节置换患者凝血功能的差异。
方法：纳入46例ASAⅠ~Ⅱ级择期行全髋关节置换的患者，随机分为高渗氯化钠羟乙基淀粉40(HSH40)预扩容组和琥珀酰明胶预扩容组，毎组23例。麻醉前HSH40预扩容组以6 mL/min的速度输注HSH40注射液3 mL/kg行预扩容，琥珀酰明胶预扩容组以20 mL/min的速度输注琥珀酰明胶10 mL/kg行预扩容。输注完毕后开始行蛛网膜下腔-硬膜外腔联合阻滞。分别在预扩容输液前、预扩容输液后60 min、置换后2 h应用血栓弹力描记仪测定纤维蛋白形成时间、血凝块生成时间、最大振幅、凝血综合指数。取2 mL静脉血，枸橼酸钠抗凝后1 500 r/min离心10 min，取血浆测定凝血酶原时间和部分激活凝血酶时间。
结果与结论：与预扩容输液前相比，预扩容输液后60 min两组患者纤维蛋白形成时间、血凝块生成时间、凝血酶原时间和部分激活凝血酶时间均延长(P < 0.05)。预扩容输液后60 min，HSH40预扩容组血凝块生成时间、部分激活凝血酶时间短于琥珀酰明胶预扩容组(P < 0.05)；置换后2 h两组患者各项凝血指标均恢复到预扩容前水平。提示3 mL/kg HSH40预扩容对全髋关节置换患者凝血功能呈短暂抑制作用，但其影响小于琥珀酰明胶，凝血功能指标均在正常范围内，可以安全应用于全髋关节置换患者。

关键词: 高渗氯化钠羟乙基淀粉40, 琥珀酰明胶, 髋关节置换, 预扩容, 凝血功能

Abstract:

BACKGROUND: There are few systemic research on coagulation for patients undergoing total hip arthroplasty with preloading hypertonic sodium chloride hydroxyletyy starch 40 (HSH40) currently.
OBJECTIVE: To compare the influence of HSH40 with succinylated gelatin on coagulation in patients during total hip arthroplasty.
METHODS: Forty-six ASAⅠ-Ⅱ patients planned for total hip arthroplasty were randomly divided into 2 groups (n=23): The patients in HSH40 group were infused 3 mL/kg hypertonic sodium chloride hydroxyletyy starch 40 (6 mL/min) or the patients in Gelofusine group were received 10 mL/kg succinylated gelatin (20 mL/min), all patients were anaesthetized with combined spinal epidural anesthesia. Value of fibrin formation time (R), blood clot formation time (k), maximum amplitude (MA), and coagulation index (CI), before (T1), 60 min after (T2) blood volume preloading and 2 hours postoperatively (T3) were measured by using thrombelastography. Prothrombin time (PT) and activated partial thromboplastin time (APTT) was detected in terms of a standard method.  
RESULTS AND CONCLUSION: Compared with T1, value of R, K, PT, APTT of two groups increased significantly at T2 (P < 0.05), K, APTT were lower for patients in HSH40 group than for patients in Gelofusine group at T2(P < 0.05). There were no statistical difference in coagulation parameters between T3 and T1 (P > 0.05). Preloading of 3 mL/kg HSH40 mildly influenced on coagulation, but the effects were weaker than succinylated gelatin, therefore, HSH40 could be safely applied in patients undergoing total hip arthroplasty.

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