Asskali F, Lehmann G, Förster H
Institut für Experimentelle Anaesthesiologie der Johann Wolfgang Goethe-Universität Frankfurt, Germany.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2002 May;37(5):258-66. doi: 10.1055/s-2002-30129.
In the study presented the effects of in vitro hemodilution with HES on coagulation are compared with the effects of in vivo hemodilution using thrombelastography (TEG). The in vivo hemodilution was performed by the i. v. infusion of 1000 ml 6 % solution of hydroxyethyl starch HES (2 formulations with HES 130/0.4 and one formulation with HES 200/0.5) in healthy volunteers during 30 min. The in vitro hemodilution was performed with blood samples taken from the volunteers before the infusion was started. These samples were diluted with HES-solution until the same hemoglobin concentration measured at the end of the infusion was attained. The in vivo TEG-parameters remained in the reference range of the method, however all in vitro TEG-parameters are out of the range of normal values. The isolated interpretation of the in vitro data shows an impairment of blood coagulation. The shortening of the reaction time as an indicator for the initiation of blood clotting points to activated coagulation by in vivo hemodilution with HES, whereas in vitro the prolongation of the reaction time is indicative for retardation of clotting. The evaluation of the TEG-parameters and of other clotting parameters determined prior to the beginning of the infusion, at the end of the infusion and four hours after termination of the infusion of HES 130/0.4 and of HES 200/0.5 to healthy volunteers show alterations of blood coagulation parameters caused mainly by dilutional effects. The more pronounced alterations found in vitro cannot be interpreted as impairment of haemostasis in vivo. On the other hand, the likewise haemodilution in vitro causes an impairment of coagulation. Therefore, the effects of in vitro hemodilution with HES on coagulation differ qualitatively and quantitatively from the effects of in vivo hemodilution.
在本研究中，使用血栓弹力图（TEG）将羟乙基淀粉（HES）体外血液稀释对凝血的影响与体内血液稀释的影响进行了比较。体内血液稀释是通过在30分钟内静脉输注1000毫升6%的羟乙基淀粉溶液（两种HES 130/0.4配方和一种HES 200/0.5配方）来完成的，健康志愿者参与其中。体外血液稀释是在输注开始前采集志愿者的血样进行的。这些样本用HES溶液稀释，直到达到输注结束时测得的相同血红蛋白浓度。体内TEG参数保持在该方法的参考范围内，然而所有体外TEG参数均超出正常值范围。对体外数据的单独解读显示凝血功能受损。反应时间缩短作为血液凝固起始的指标表明，HES体内血液稀释激活了凝血，而在体外，反应时间延长表明凝血延迟。对健康志愿者输注HES 130/0.4和HES 200/0.5开始前、输注结束时以及输注结束后四小时测定的TEG参数和其他凝血参数进行评估，结果显示凝血参数的改变主要由稀释效应引起。在体外发现的更明显的改变不能被解释为体内止血功能受损。另一方面，同样的体外血液稀释也会导致凝血功能受损。因此，HES体外血液稀释对凝血的影响在质量和数量上与体内血液稀释的影响不同。
