Hwang Sung Ho, Won Yu Sam, Yu Jang Sun, Yang Jae Young, Choi Chun Sik
Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2007 Nov;42(5):377-81. doi: 10.3340/jkns.2007.42.5.377. Epub 2007 Nov 20.
High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than does low-molecular-weight HES. We compared the effects of low- and high-molecular-weight HES for the treatment of vasospasm and investigated the dose relationship with each other.
Retrospectively, in a series of consecutive 102 patients with subarachnoid hemorrhage (SAH), 35 patients developed clinical symptoms of vasospasm of these fourteen patients were treated with low-molecular-weight HES for volume expansion while the other 21 received high-molecular-weight HES as continuous intravenous infusion. Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen level, and platelet count were all measured prior to initiation, during treatment and after termination of therapy for symptomatic vasospasm. The total dose of HES ranged from 5 L to 14 L and median infusion duration was 10 days.
A more pronounced PTT prolongation was observed in high-molecular-weight HES group compared with low-molecular-weight HES group. No other coagulation parameters were altered. Dosage (=duration) shows a positive correlation with PTT. Clinically, significant bleeding episodes were noted in four patients who received high-molecular-weight HES.
Coagulopathy was developed in direct proportion to molecular weight of starch and dosages. We propose the extreme caution in the administration of HES solution for the vasospasm treatment.
与低分子量羟乙基淀粉（HES）相比，高分子量HES对血液凝固的影响更大。我们比较了低分子量和高分子量HES治疗血管痉挛的效果，并研究了它们之间的剂量关系。
回顾性分析连续102例蛛网膜下腔出血（SAH）患者，其中35例出现血管痉挛临床症状，这14例患者中，14例接受低分子量HES扩容治疗，另外21例接受高分子量HES持续静脉输注。在症状性血管痉挛治疗开始前、治疗期间和治疗结束后，均检测凝血酶原时间（PT）、部分凝血活酶时间（PTT）、纤维蛋白原水平和血小板计数。HES的总剂量为5L至14L，中位输注持续时间为10天。
与低分子量HES组相比，高分子量HES组观察到更明显的PTT延长。其他凝血参数均未改变。剂量（=持续时间）与PTT呈正相关。临床上，接受高分子量HES治疗的4例患者出现明显出血事件。
凝血功能障碍与淀粉的分子量和剂量成正比。我们建议在使用HES溶液治疗血管痉挛时应格外谨慎。
