Kimenai D M, Bastianen G W, Daane C R, Megens-Bastiaanse C M, van der Meer N J M, Scohy T V, Gerritse B M
1Department of Extracorporeal Circulation, Amphia Hospital, Breda, The Netherlands.
Perfusion. 2013 Nov;28(6):512-9. doi: 10.1177/0267659113491446. Epub 2013 Jun 6.
The choice of the prime solution for cardiopulmonary bypass can play an important role in limiting the effect on blood coagulation, but it is still unclear what the effect of colloids on blood coagulation is. The aim of this study was to investigate the effect of synthetic colloids on blood loss and blood coagulation in patients after on-pump coronary artery bypass graft (CABG) procedures.
Sixty elective, on-pump CABG patients were randomly assigned to receive the prime solutions lactated Ringer's solution combined with hydroxyethyl starch 130/0.4 (HES, 6% Volulyte, Fresenius Kabi Nederland BV, Zeist, the Netherlands) (HES group) or gelatin (Gelofusin(®), B Braun Melsung AG, Melsungen, Germany) (Gelo group). Blood loss was assessed using post-operative chest tube output; secondary endpoints were number of blood component transfusions, routine coagulation test values and rotation thromboelastometry values (Rotem(®) delta, Pentapharm GmbH, Munich, Germany).
Total post-operative chest tube output was 500 ± 420 ml in the HES group versus 465 ± 390 ml in the Gelo group (p = 0.48). No significant differences were observed in any of the routine coagulation tests values, thromboelastometry parameters or number of blood component transfusions between the groups.
In this randomized, controlled trial of adults after on-pump CABG procedures, there was no significant difference in blood loss or blood coagulation between the HES group and the Gelo group.
体外循环预充液的选择在限制对凝血的影响方面可能起着重要作用，但胶体对凝血的影响仍不清楚。本研究的目的是调查合成胶体对冠状动脉搭桥术（CABG）术后患者失血和凝血的影响。
60例择期体外循环CABG患者被随机分配接受预充液乳酸林格氏液联合羟乙基淀粉130/0.4（HES，6%万汶，费森尤斯卡比荷兰公司，荷兰泽斯）（HES组）或明胶（佳乐施，贝朗医疗有限公司，德国梅尔松根）（佳乐组）。通过术后胸腔引流管引流量评估失血量；次要终点为血液成分输注次数、常规凝血试验值和旋转血栓弹力图值（德国慕尼黑Pentapharm有限公司的Rotemδ）。
HES组术后胸腔引流管总引流量为500±420ml，佳乐组为465±390ml（p = 0.48）。两组之间在任何常规凝血试验值、血栓弹力图参数或血液成分输注次数方面均未观察到显著差异。
在这项关于成人体外循环CABG术后的随机对照试验中，HES组和佳乐组在失血或凝血方面无显著差异。
