Haas T, Preinreich A, Oswald E, Pajk W, Berger J, Kuehbacher G, Innerhofer P
Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
Anaesthesia. 2007 Oct;62(10):1000-7. doi: 10.1111/j.1365-2044.2007.05186.x.
Albumin is often cited in textbooks as the gold standard for fluid replacement in paediatrics, but in practice artificial colloids are more frequently used. Although one concern with the use of artificial colloids is their intrinsic action on haemostasis, the available data in children are inconclusive for 6% hydroxyethyl starch 130/0.4 (HES) and no data exist for gelatine solution with respect to coagulation. A total of 42 children (3-15 kg) undergoing surgery and needing colloid replacement were randomly assigned to receive 15 mlxkg(-1) of either albumin 5%, 4% modified gelatine solution or 6% hydroxyethyl starch 130/0.4 solution. Standard coagulation tests and modified thrombelastography (ROTEM) were performed. After colloid administration, routine coagulation test results changed significantly and comparably in all groups, although activated partial thromboplastin time values increased more with gelatine and HES. Coagulation time was unchanged in the children who received albumin or gelatine but other activated modified thrombelastography values were significantly impaired in all groups. After gelatine and after albumin the median clot firmness decreased significantly but remained within the normal range. Following HES, coagulation time increased significantly, and clot formation time, alpha angle, clot firmness, and fibrinogen/fibrin polymerisation were significantly more impaired than for albumin or gelatine, reaching median values below the normal range. From a haemostatic point of view it might be preferable to use gelatine solution as an alternative to albumin; HES showed the greatest effects on the overall coagulation process.
白蛋白在儿科教科书上常被视为液体替代的金标准，但在实际应用中，人工胶体的使用更为频繁。虽然使用人工胶体的一个担忧是其对止血的内在作用，但关于6%羟乙基淀粉130/0.4（HES）在儿童中的现有数据尚无定论，且关于明胶溶液对凝血作用的数据也不存在。共有42名接受手术且需要胶体替代的儿童（体重3 - 15千克）被随机分配接受15毫升/千克⁻¹的5%白蛋白、4%改良明胶溶液或6%羟乙基淀粉130/0.4溶液。进行了标准凝血试验和改良血栓弹力图（ROTEM）检测。胶体给药后，所有组的常规凝血试验结果均有显著且相似的变化，尽管活化部分凝血活酶时间值在明胶和HES组升高得更多。接受白蛋白或明胶的儿童凝血时间未变，但所有组的其他活化改良血栓弹力图值均显著受损。给予明胶和白蛋白后，血块硬度中位数显著下降，但仍在正常范围内。给予HES后，凝血时间显著增加，血块形成时间、α角、血块硬度以及纤维蛋白原/纤维蛋白聚合均比白蛋白或明胶组受损更严重，中位数低于正常范围。从止血角度看，使用明胶溶液替代白蛋白可能更可取；HES对整体凝血过程影响最大。
