Diehl J T, Lester J L, Cosgrove D M
Ann Thorac Surg. 1982 Dec;34(6):674-9. doi: 10.1016/s0003-4975(10)60907-1.
Hetastarch, 6% hydroxyethyl starch solution, is an artificial colloid proposed for use as a volume expander. There is concern that hetastarch, like dextran, may adversely affect coagulation. To compare the effects of hetastarch with 5% albumin in postoperative patients, 60 consecutive patients who underwent coronary artery bypass were prospectively randomized into two study groups. Both groups were comparable in all respects preoperatively. Group 1 (27 patients) received a mean of 1,241 ml of 5% albumin and Group 2 (33 patients) a mean of 1,210 ml of hetastarch as volume replacement within the first 24 postoperative hours. Indices of postoperative hepatic, renal, and pulmonary function did not differ significantly between the groups immediately postoperatively, at 24 hours postoperatively, or at 7 days postoperatively. Hematocrits, platelet counts, prothrombin times, partial thromboplastin times, and serum fibrinogen levels were comparable between the two groups at all times. The mean volume of chest tube drainage did not differ between the groups (Group 1, 495 +/- 216 ml; Group 2, 637 +/- 402 ml; not significant), and no patient required reexploration for bleeding. Eighteen percent of Group 1 and 15% of Group 2 patients received banded blood during their hospitalization and required similar amounts (Group 1, 0.37 unit per patient; Group 2, 0.36 unit per patient; not significant). The use of hetastarch as a postoperative volume expander after myocardial revascularization is safe and effective, and results in substantial financial savings.
羟乙基淀粉，6%羟乙基淀粉溶液，是一种被提议用作容量扩充剂的人工胶体。有人担心羟乙基淀粉与右旋糖酐一样，可能会对凝血产生不利影响。为比较羟乙基淀粉与5%白蛋白对术后患者的影响，60例连续接受冠状动脉搭桥手术的患者被前瞻性随机分为两个研究组。两组术前在各方面均具有可比性。第1组（27例患者）在术后24小时内平均接受1241毫升5%白蛋白，第2组（33例患者）平均接受1210毫升羟乙基淀粉作为容量替代。术后两组患者的肝、肾和肺功能指标在术后即刻、术后24小时或术后7天并无显著差异。两组患者在所有时间点的血细胞比容、血小板计数、凝血酶原时间、部分凝血活酶时间和血清纤维蛋白原水平均具有可比性。两组胸管引流量平均无差异（第1组，495±216毫升；第2组，637±402毫升；无显著差异），且无患者因出血需要再次手术探查。第1组18%的患者和第2组15%的患者在住院期间接受了浓缩红细胞输注，且输注量相似（第1组，每位患者0.37单位；第2组，每位患者0.36单位；无显著差异）。心肌血运重建术后使用羟乙基淀粉作为容量扩充剂是安全有效的，且能大幅节省费用。
