Liang Hua, Yang Cheng-Xiang, Li Heng, Liu Hong-Zhen, Wang Han-Bing
Department of Anesthesiology, Affiliated Foshan Hospital, Sun Yat-sen University, Foshan, Guangdong, 528000, P. R. China.
Ai Zheng. 2006 Oct;25(10):1256-60.
BACKGROUND & OBJECTIVE: Cancer patients have an increased risk of thrombosis after operation because of a hypercoagulable status. Therefore, anticoagulant treatment is necessary for patients with hypercoagulability during perioperative period. This study was to investigate the effect of acute hypervolemic hemodilution (AHHD) with 6% hydroxyethyl starch (HES), or 4% succinylated gelatin (GEL), or lactated Ringer's (RL) solution before operation on the hypercoagulable status and the occurrence of deep venous thrombosis (DVT) of patients with colon cancer.
Sixty colon cancer patients with hypercoagulable status underwent operation were randomized into HES, GEL, and RL groups; each group contained 20 patients. The patients were infused with HES, GEL, or RL solution respectively at a dose of 15 ml/kg within 30 min before operation. Preoperative coagulation function was assessed by thrombelastography (TEG). DVT was diagnosed by the color Doppler ultrasonic system.
Acute hypervolemic hemodilution with HES solution led to a significant decrease of coagulation index (CI) at 30 min and 2 h after starting operation and 1 h after operation as compared with the prehemodilution value (P<0.01). At 1 h after operation, CI was significantly lower in HES group than in GEL group (P<0.05). At 30 min and 2 h after starting operation and 1 h after operation, CI was significantly lower in HES group than in RL group (P<0.05). Hemodilution with GEL solution lessened CI at 30 min and 2 h after starting operation significantly as compared with the prehemodilution value (P<0.01). At 30 min and 2 h after starting operation, CI was significantly lower in GEL group than in RL group (P<0.05). After operation, DVT in occurred 2 (10%) patients in HES group, 3 (15%) in GEL group, and 10 (50%) in RL group (P<0.05).
Acute hypervolemic hemodilution with HES solution and GEL solution can alleviate the hypercoagulability of colon cancer patients during perioperative period and decrease the occurrence of DVT.
癌症患者术后因处于高凝状态而发生血栓形成的风险增加。因此，围手术期对具有高凝性的患者进行抗凝治疗很有必要。本研究旨在探讨术前应用6%羟乙基淀粉（HES）、4%琥珀酰明胶（GEL）或乳酸林格氏液（RL）进行急性高容量血液稀释（AHHD）对结肠癌患者高凝状态及深静脉血栓形成（DVT）发生情况的影响。
将60例具有高凝状态的结肠癌手术患者随机分为HES组、GEL组和RL组，每组20例。术前30分钟内分别按15 ml/kg的剂量给患者输注HES、GEL或RL溶液。采用血栓弹力图（TEG）评估术前凝血功能。通过彩色多普勒超声系统诊断DVT。
与血液稀释前相比，应用HES溶液进行急性高容量血液稀释后，手术开始后30分钟、2小时及术后1小时凝血指数（CI）显著降低（P<0.01）。术后1小时，HES组CI显著低于GEL组（P<0.05）。手术开始后30分钟、2小时及术后1小时，HES组CI显著低于RL组（P<0.05）。与血液稀释前相比，应用GEL溶液进行血液稀释后，手术开始后30分钟和2小时CI显著降低（P<0.01）。手术开始后30分钟和2小时，GEL组CI显著低于RL组（P<0.05）。术后，HES组有2例（10%）发生DVT，GEL组有3例（15%），RL组有10例（50%）（P<0.05）。
应用HES溶液和GEL溶液进行急性高容量血液稀释可缓解结肠癌患者围手术期的高凝状态，减少DVT的发生。
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