Heilmann L, Hojnacki B
Gynäkologisch-geburtshilfliche Abteilung, Stadtkrankenhaus Rüsselsheim, BRD.
Acta Med Austriaca. 1991;18 Suppl 1:56-9.
The ability to produce a large increase in plasma volume is one of the hallmarks of a successful pregnancy. Data from Garn et al. (5), Knottnerus et al. (14) and Murphy et al. (15) have shown, that hemoglobin levels above 13 g/dl or hematocrit 38% before admittance to hospital are associated with a high incidence of IUGR (intrauterine growth retardation), gestational hypertension and with a greater perinatal mortality. Patients with an elevated viscosity and hematocrit have increased perinatal risks. In these cases the hemodilution with hydroxy- ethylstarch (HES) improves the blood flow and decreases the incidence of dysmature babies and pregnancy complications. The effect of HES on certain coagulation assays seems qualitatively similar to those of Dextran. In a prospective trial we evaluated the effect of HES in the incidence of thrombosis after cesarean section and we found a 5.9% incidence of thrombosis in patients treated with 6% HES 0.62 compared with a 7.8% incidence in heparin treated patients. Treatment with 1500 ml 6% HES 0.62 before and after cesarean section is similarly effective in preventing deep vein thrombosis as heparin prophylaxis.
血浆量大幅增加的能力是成功怀孕的标志之一。加恩等人（5）、克诺特努斯等人（14）以及墨菲等人（15）的数据表明，入院前血红蛋白水平高于13 g/dl或血细胞比容高于38%与宫内生长受限（IUGR）、妊娠期高血压的高发生率以及更高的围产期死亡率相关。血液黏度和血细胞比容升高的患者围产期风险增加。在这些情况下，用羟乙基淀粉（HES）进行血液稀释可改善血流并降低未成熟儿和妊娠并发症的发生率。HES对某些凝血检测的影响在质量上似乎与右旋糖酐相似。在一项前瞻性试验中，我们评估了HES对剖宫产术后血栓形成发生率的影响，结果发现，接受6% HES 0.62治疗的患者血栓形成发生率为5.9%，而接受肝素治疗的患者为7.8%。剖宫产前后使用1500 ml 6% HES 0.62预防深静脉血栓的效果与肝素预防相似。
