Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Clin Appl Thromb Hemost. 2010 Feb;16(1):91-8. doi: 10.1177/1076029608330474. Epub 2009 Oct 13.
The purpose of this study was to investigate the effects of acute hypervolemic fluid infusion (AHFI) of 6% hydroxyethyl starch (HES) 130/0.4 or 4% succinylated gelatin (GEL) on hemostasis and the possible mechanisms.
Thirty-six gastric cancer patients were randomized to receive AHFI of either HES, GEL or lactated Ringer's (RL) solution at the rate of 30 mL x kg(-1) x h( -1) from 20 minutes before to 40 minutes after induction of general anesthesia.
Group HES and GEL had significantly prolonged PT and aPTT, decreased VIII:C and vWF immediately after AHFI. Statistically prolonged reaction time and coagulation time, and decreased growth angle were seen immediately after HES infusion. Maximum amplitude decreased significantly in group HES and GEL immediately after and 4 hours after AHFI.
Gelatin reduced clot quality associated with derangements of fibrin polymerization and HES 130/0.4 delayed initiation of sufficient thrombin generation to convert fibrinogen to fibrin and impaired platelet function.
本研究旨在探讨急性高容量液体输注（AHFI）6%羟乙基淀粉（HES）130/0.4 或 4%琥珀酰明胶（GEL）对止血的影响及其可能的机制。
36 例胃癌患者随机分为 HES 组、GEL 组或乳酸林格氏液（RL）组，分别于全麻诱导前 20 分钟至诱导后 40 分钟以 30 mL·kg(-1)·h(-1)的速度输注。
HES 组和 GEL 组的 PT 和 aPTT 在 AHFI 后即刻显著延长，VIII:C 和 vWF 降低。HES 输注后即刻出现反应时间和凝血时间延长，生长角度降低。HES 组和 GEL 组在 AHFI 后即刻和 4 小时后最大振幅显著降低。
明胶降低了与纤维蛋白聚合紊乱相关的血凝块质量，HES 130/0.4 延迟了足够的凝血酶生成以将纤维蛋白原转化为纤维蛋白，并损害了血小板功能。
