Sevcikova Silvie, Vymazal Tomas, Durila Miroslav
Clin Lab. 2017 Oct 1;63(10):1691-1700. doi: 10.7754/Clin.Lab.2017.170505.
Fluid resuscitation with crystalloid and colloid solutions is a common treatment in perioperative medicine. However, a variety of unbalanced or balanced solutions are used in clinical practice and there is still vivid debate going on regarding selection of optimal fluid with minimal negative effect on coagulation to minimize bleeding and blood transfusion requirements. The aim of the study was to investigate adverse effects of balanced crystalloids and colloids on coagulation measured by thromboelastometry in vitro.
Blood samples were obtained from healthy volunteers undergoing knee arthroscopy. Adverse effects of balanced crystalloid, hydroxyethyl starch, and gelatin were evaluated by thromboelastometry after 20% dilution of blood with the solution in vitro. Parameters of EXTEM and FIBTEM test were evaluated.
Clotting time of EXTEM was not significantly influenced by any of the investigated solutions (p > 0.05). However, significant impairment of clot formation time of EXTEM was detected in hydroxyethyl starch and gelatin groups in comparison with controls (p < 0.05), while crystalloid did not affect this parameter significantly (p > 0.05). Similar results were found in α angle although significant coagulopathy effect was found only in hydroxyethyl starch samples (p < 0.05). Maximum clot firmness of EXTEM and FIBTEM tests was significantly affected by both hydroxyethyl starch and gelatin (p < 0.05) but not by crystalloid.
Balanced crystalloid solution does not seem to have a negative influence on the coagulation process as measured by thromboelastometry. On the other hand, balanced colloids may impair propagation phase of coagulation, strength of coagulum, and level of functional fibrinogen. Hydroxyethyl starch seems to have a stronger anticoagulant effect compared to gelatin.
晶体液和胶体液进行液体复苏是围手术期医学中的常见治疗方法。然而，临床实践中使用了各种不平衡或平衡溶液，关于选择对凝血影响最小以尽量减少出血和输血需求的最佳液体仍存在激烈争论。本研究的目的是通过体外血栓弹力图测定法研究平衡晶体液和胶体液对凝血的不良影响。
从接受膝关节镜检查的健康志愿者采集血样。体外将血液用溶液稀释20%后，通过血栓弹力图测定法评估平衡晶体液、羟乙基淀粉和明胶的不良影响。评估EXTEM和FIBTEM试验参数。
EXTEM的凝血时间未受到任何研究溶液的显著影响（p>0.05）。然而，与对照组相比，羟乙基淀粉和明胶组中EXTEM的凝块形成时间有显著受损（p<0.05），而晶体液对该参数无显著影响（p>0.05）。α角也有类似结果，尽管仅在羟乙基淀粉样本中发现显著的凝血病效应（p<0.05）。EXTEM和FIBTEM试验的最大凝块硬度受到羟乙基淀粉和明胶两者的显著影响（p<0.05），但不受晶体液影响。
通过血栓弹力图测定法测量，平衡晶体液似乎对凝血过程没有负面影响。另一方面，平衡胶体可能会损害凝血的传播阶段、凝块强度和功能性纤维蛋白原水平。与明胶相比，羟乙基淀粉似乎具有更强的抗凝作用。
