Roche A M, James M F M, Grocott M P W, Mythen M G
Research Fellow, Centre for Anaesthesia, University College London, First Floor Crosspiece, Middlesex Hospital, Mortimer Street, London, W1T 3AA, UK.
Anaesthesia. 2002 Oct;57(10):950-5. doi: 10.1046/j.1365-2044.2002.02707.x.
The hydroxyethyl starches are a group of compounds that has been associated with impairment of coagulation when large volumes are administered. The thrombelastograph is commonly used to assess point-of-care whole blood coagulation. Little is known about the dose-response relationships of haemodilution, and it is reasonable to assume that a linear association exists. This may not be the case with altered electrolyte compositions of the fluids used for haemodilution. We have therefore conducted an in vitro study of haemodilution of human whole blood using lactated Ringer's solution and two high molecular weight hetastarches, one in a balanced salt solution, the other in a 0.9% saline solution. The thrombelastograph, commonly used for the assessment of the coagulation effects of synthetic colloids, was used as the coagulation assessment device. Serial haemodilution with hetastarch in a balanced salt solution demonstrated a biphasic response (of r-times and k-times, as well as alpha angles), with haemodilution in the 20-40% range causing enhanced coagulation, and higher degrees of dilution causing a decrease in overall coagulation performance. A similar picture was observed with lactated Ringer's solution, but only significantly so in alpha angles. Hetastarch in saline did not display this initial increased coagulability at mild to moderate dilutions. This biphasic response of lactated Ringer's solution and hetastarch in a balanced salt solution reflects the complex interaction of fluids and the coagulation system, and that these effects cannot be attributed to simple haemodilution. On the other hand, there was a linear decrease in maximum amplitude with haemodilution. Maximum amplitude was particularly affected by both starches, which is an expected finding in view of the known interaction between the hydroxyethyl starches and von Willebrand's factor.
羟乙基淀粉是一类化合物，大量输注时会导致凝血功能受损。血栓弹力图仪常用于评估即时全血凝血情况。关于血液稀释的剂量反应关系知之甚少，合理推测存在线性关联。但用于血液稀释的液体电解质成分改变时情况可能并非如此。因此，我们进行了一项体外研究，使用乳酸林格氏液和两种高分子量贺斯淀粉对人全血进行血液稀释，一种贺斯淀粉溶解于平衡盐溶液，另一种溶解于0.9%盐溶液。血栓弹力图仪常用于评估合成胶体的凝血效果，此次用作凝血评估设备。用溶解于平衡盐溶液的贺斯淀粉进行系列血液稀释显示出双相反应（r值和k值以及α角），20%至40%范围的血液稀释会增强凝血，更高程度的稀释会导致整体凝血性能下降。乳酸林格氏液也观察到类似情况，但仅α角有显著变化。溶解于盐溶液的贺斯淀粉在轻度至中度稀释时未表现出这种初始凝血性增加。乳酸林格氏液和溶解于平衡盐溶液的贺斯淀粉的这种双相反应反映了液体与凝血系统的复杂相互作用，且这些效应不能简单归因于血液稀释。另一方面，随着血液稀释最大振幅呈线性下降。两种淀粉都对最大振幅有特别影响，鉴于羟乙基淀粉与血管性血友病因子之间已知的相互作用，这是预期的发现。
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