Heilmann L, Heitz R, Koch F U, Ose C
Abt. Gynäkologie und Geburtshilfe, Stadtkrankenhauses Rüsselsheim.
Z Geburtshilfe Perinatol. 1991 Jan-Feb;195(1):10-5.
In 207 consecutive randomized women undergoing cesarean section, of whom 104 received 3 X 5000 IE unfractionated heparin and 103 3 X 500 ml hydroxyethylstarch 6% 0.62, the frequency of deep vein thrombosis was evaluated with a non-invasive diagnostic technique-impedance plethysmography. 5.9% of the patients in the hydroxyethylstarch group and 7.8% in the heparin-group developed deep vein thrombosis. Activation of blood coagulation at cesarean section results in an increasing of factor VIIIR:Ag, Fibrinogen and Reptilase clotting time. Hydroxyethylstarch 6% 0.62 produces minor abnormalities of coagulation test results. After 1500 ml infusions HES the following effects were noted: 1. Factor VIIIR:Ag fell by about 20%, a greater decrease than could be explained simply by hemodilution. 2. Reptilase clotting times shortened without a different increase in fibrin activation products (resulting in an increased lysability of the thrombus). 3. Plasma fibrinogen decreased by approximately 7% due to hemodilution caused by plasma volume expansion. For patients with a low risk of deep vein thrombosis (Cesarean section) HES has an excellent safety record in doses not exceeding 1500 ml/24 h.
在207例连续接受剖宫产的随机分组女性中，104例接受3×5000国际单位普通肝素，103例接受3×500毫升6%羟乙基淀粉0.62，采用无创诊断技术——阻抗体积描记法评估深静脉血栓形成的发生率。羟乙基淀粉组5.9%的患者和肝素组7.8%的患者发生了深静脉血栓形成。剖宫产时血液凝固的激活导致因子VIIIR:Ag、纤维蛋白原和爬虫酶凝血时间增加。6% 0.62羟乙基淀粉导致凝血试验结果出现轻微异常。输注1500毫升羟乙基淀粉后观察到以下效应：1. 因子VIIIR:Ag下降约20%，下降幅度大于单纯血液稀释所能解释的程度。2. 爬虫酶凝血时间缩短，而纤维蛋白激活产物无不同程度增加（导致血栓的溶解能力增强）。3. 由于血浆容量扩充引起的血液稀释，血浆纤维蛋白原降低约7%。对于深静脉血栓形成低风险的患者（剖宫产），羟乙基淀粉在不超过1500毫升/24小时的剂量下具有出色的安全记录。
