Nielsen Vance G
Department of Anesthesiology, University of Alabama at Birmingham, 619 South 19th Street, 35249-6810, USA.
J Surg Res. 2006 May;132(1):17-22. doi: 10.1016/j.jss.2005.07.025. Epub 2005 Sep 8.
Hydroxyethyl starch administration has been associated with decreases in hemostasis and has recently been demonstrated to decrease fibrinogen (FI)-thrombin-(FIIa)-Factor XIII (FXIII) interactions in vitro in human plasma. Thus, the purpose of the present study was to determine the effect of in vivo hemodilution with Hextend (6% hydroxyethyl starch, mean molecular weight 450 kDa) on plasma coagulation kinetics.
Eight male, New Zealand White rabbits were intravenously administered with 20 ml/kg of Hextend. Citrated plasma was obtained before, 1 min after, and 1 h after hemodilution. Thrombelastographic analyses were performed, with clot initiation (R, sec), clot propagation (alpha, degrees), and clot strength (shear elastic modulus, G, dynes/cm(2)) determined over 20 min. Samples were celite-activated and had either with addition or without additions of FI, FIIa or activated FXIII (FXIIIa) to restore protein content to prediluted values.
There was no significant difference in R values observed before (229 +/- 30), 1 min after (241 +/- 54), and 1 h after (214 +/- 42) hemodilution. Prediluted alpha values (75.2 +/- 1.9) were significantly decreased 1 min (53.3 +/- 5.9) and 1 h after hemodilution (56.1 +/- 10.2). Prediluted G values (1,992 +/- 434) were significantly reduced 1 min (532 +/- 195) and 1 h after (630 +/- 297) hemodilution. FI, FIIa, and FXIIIa addition significantly decreased R values after hemodilution. alpha and G values were significantly improved by FI and FXIIIa after hemodilution. FIIa addition did not significantly affect alpha or G.
Hextend hemodilution in rabbits maintains clot initiation by diminishing both FIIa-FI and FXIIIa-fibrin interactions, whereas clot propagation and strength were reduced by diminished FXIIIa-fibrin interactions.
羟乙基淀粉的应用与止血功能降低有关，最近有研究表明其在体外可降低人血浆中纤维蛋白原（FI）-凝血酶-（FIIa）-因子 XIII（FXIII）的相互作用。因此，本研究旨在确定用贺斯（6%羟乙基淀粉，平均分子量 450 kDa）进行体内血液稀释对血浆凝血动力学的影响。
8 只雄性新西兰白兔静脉注射 20 ml/kg 的贺斯。在血液稀释前、稀释后 1 分钟和 1 小时采集枸橼酸化血浆。进行血栓弹力图分析，在 20 分钟内测定凝血起始时间（R，秒）、凝血传播速度（α，度）和凝血强度（剪切弹性模量，G，达因/cm²）。样本用硅藻土激活，分别添加或不添加 FI、FIIa 或活化的 FXIII（FXIIIa）以将蛋白质含量恢复到稀释前的值。
血液稀释前（229±30）、稀释后 1 分钟（241±54）和 1 小时后（214±42）的 R 值无显著差异。稀释前的α值（75.2±1.9）在血液稀释后 1 分钟（53.3±5.9）和 1 小时后（56.1±10.2）显著降低。稀释前的 G 值（1992±434）在血液稀释后 1 分钟（532±195）和 1 小时后（630±297）显著降低。添加 FI、FIIa 和 FXIIIa 后血液稀释后的 R 值显著降低。血液稀释后，FI 和 FXIIIa 可显著改善α和 G 值。添加 FIIa 对α或 G 无显著影响。
兔体内用贺斯进行血液稀释通过减少 FIIa-FI 和 FXIIIa-纤维蛋白的相互作用维持凝血起始，而凝血传播和强度因 FXIIIa-纤维蛋白相互作用减少而降低。
