低分子量和中分子量羟乙基淀粉：它们对血液凝固作用的比较

Low- and medium-molecular-weight hydroxyethyl starches: comparison of their effect on blood coagulation.

作者信息

Jamnicki M, Bombeli T, Seifert B, Zollinger A, Camenzind V, Pasch T, Spahn D R

机构信息

Institute of Anesthesiology, University Hospital, Zurich, Switzerland.

出版信息

Anesthesiology. 2000 Nov;93(5):1231-7. doi: 10.1097/00000542-200011000-00016.

DOI:10.1097/00000542-200011000-00016

PMID:11046211

Abstract

BACKGROUND

High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than medium-molecular-weight HES. The authors compared medium molecular weight HES (200 kd [HES200]) and low-molecular-weight HES (70 kd [HES70]).

METHODS

In a prospective, double-blind, randomized-sequence crossover study, 22 male volunteers received 15 ml/kg HES200 and HES70. Blood samples were taken before and 5 min, 30 min, 1 h, 2 h, 4 h, 8 h, and 24 h after infusion. The following parameters were analyzed at all time points: prothrombin time, activated partial thromboplastin time, fibrinogen, factor VIII, antigenetic and functional von Willebrand factor, platelets, Thrombelastograph analysis parameters (reaction time, coagulation time, maximum amplitude, angle alpha, and clot lysis 30 and 60 min after maximum amplitude), ionized calcium, hematocrit, HES plasma concentration, molecular weight (weight average and number average), molar substitution, and polydispersity (weight average/number average). Repeated-measures analysis of variance (P < 0.05) was used to compare the response of the aforementioned parameters to the infusion of HES70 and HES200.

RESULTS

Both HES solutions had a significant impact on all parameters. A slightly greater compromise with HES200 was found in activated partial thromboplastin time (P = 0.010), factor VIII (P = 0.009), antigenetic von Willebrand factor (P = 0.041), functional von Willebrand factor (P = 0.026), maximum amplitude (P = 0.008), and angle alpha (P = 0.003). No difference was established with the other parameters. HES concentration (P < 0.001), weight average (P < 0.001), number average (P < 0.001), and polydispersity (P < 0.001) were higher with HES200. There was no difference with molar substitution (P = 0.091).

CONCLUSIONS

Low-molecular-weight hydroxyethyl starch (70 kd) compromises blood coagulation slightly less than HES200, but it is unclear whether this is clinically relevant.

摘要

背景

与中分子量羟乙基淀粉相比，高分子量羟乙基淀粉对血液凝固的影响更大。作者比较了中分子量羟乙基淀粉（200kd [HES200]）和低分子量羟乙基淀粉（70kd [HES70]）。

方法

在一项前瞻性、双盲、随机序列交叉研究中，22名男性志愿者接受了15ml/kg的HES200和HES70。在输注前以及输注后5分钟、30分钟、1小时、2小时、4小时、8小时和24小时采集血样。在所有时间点分析以下参数：凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、凝血因子VIII、血管性血友病因子抗原和活性、血小板、血栓弹力图分析参数（反应时间、凝血时间、最大振幅、α角以及最大振幅后30分钟和60分钟的血块溶解）、离子钙、血细胞比容、羟乙基淀粉血浆浓度、分子量（重均分子量和数均分子量）、摩尔取代度和多分散性（重均分子量/数均分子量）。采用重复测量方差分析（P<0.05）比较上述参数对HES70和HES200输注的反应。

结果

两种羟乙基淀粉溶液对所有参数均有显著影响。在活化部分凝血活酶时间（P = 0.010）、凝血因子VIII（P = 0.009）、血管性血友病因子抗原（P = 0.041）、血管性血友病因子活性（P = 0.026）、最大振幅（P = 0.008）和α角（P = 0.003）方面，发现HES200的影响略大。其他参数未发现差异。HES200的浓度（P<0.001）、重均分子量（P<0.001）、数均分子量（P<0.001）和多分散性（P<0.001）更高。摩尔取代度无差异（P = 0.091）。