Belcher P, Lennox S C
Ann Thorac Surg. 1984 May;37(5):365-70. doi: 10.1016/s0003-4975(10)60756-4.
Banked blood transfusion, with its attendant hazards, may be avoided in certain instances. A search for an acceptable plasma substitute was made. A randomized prospective trial of hydroxyethyl starch (HES) versus plasma for postoperative volume replacement is described. Ninety patients undergoing operations for coronary artery disease were studied over a six-month period. Ten received banked blood in the immediate postoperative period and were excluded from the study. The remaining 80 were randomized into two groups. Group 1 received plasma, and Group 2 received HES. All patients initially had autologous blood transfusion, and in 7 patients this sufficed; these patients were excluded from the study except for regression analysis. Postoperative blood loss and urine output did not differ between groups, but Group 2 patients required significantly more volume replacement (p less than 0.02). In a total of 27 patients drawn from both groups, coagulation factors and colloid osmotic pressure were investigated. There were no significant differences in fibrinogen titer and prothrombin time between groups, but return to normal values was significantly delayed in the HES group (p less than 0.01). Activated clotting time and partial thromboplastin time were unaffected. Colloid osmotic pressure was significantly higher at one week in the HES group (p less than 0.001) and was correlated with the volume of HES given (r = 0.525; p less than 0.01). There were no untoward effects attributable to HES. It is concluded that HES is a safe, cheap, and effective plasma substitute for volume replacement following cardiac surgical procedures.
在某些情况下，可以避免使用存在相关风险的库存血输血。于是开始寻找一种可接受的血浆替代品。本文描述了一项关于羟乙基淀粉（HES）与血浆用于术后容量替代的随机前瞻性试验。在六个月的时间里，对90例接受冠状动脉疾病手术的患者进行了研究。其中10例在术后即刻接受了库存血输血，被排除在研究之外。其余80例被随机分为两组。第1组接受血浆，第2组接受HES。所有患者最初均接受自体输血，其中7例仅自体输血就足够了；这些患者除进行回归分析外，均被排除在研究之外。两组患者术后失血量和尿量无差异，但第2组患者需要显著更多的容量替代（p<0.02）。从两组中共抽取27例患者，对其凝血因子和胶体渗透压进行了研究。两组之间纤维蛋白原滴度和凝血酶原时间无显著差异，但HES组恢复至正常水平的时间显著延迟（p<0.01）。活化凝血时间和部分凝血活酶时间未受影响。HES组在一周时胶体渗透压显著更高（p<0.001），且与给予的HES量相关（r = 0.525；p<0.01）。未发现HES有不良影响。结论是，HES是心脏外科手术后用于容量替代的一种安全、廉价且有效的血浆替代品。
