Boldt J, Heesen M, Welters I, Padberg W, Martin K, Hempelmann G
Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
Br J Anaesth. 1995 Dec;75(6):740-6. doi: 10.1093/bja/75.6.740.
The endothelium plays an important role in the regulation of haemostasis by producing substances such as thrombomodulin (TM). The influence of long-term volume replacement with different types of fluid on the TM-protein C-protein S system was investigated in a prospective, randomized study. Thirty trauma patients and 30 patients suffering from sepsis after major surgery received either 10% low-molecular weight (LMW) hydroxyethylstarch solution (HES-trauma, n = 15; HES-sepsis, n = 15) or 20% human albumin (HA-trauma, n = 15; HA-sepsis, n = 15) for 5 days to maintain central venous pressure (CVP) between 12 and 16 mm Hg. Plasma concentrations of TM, protein C, (free) protein S and thrombin-antithrombin (TAT) were measured in arterial blood samples obtained on the day of admission to the intensive care unit or on the day of diagnosis of sepsis and over the next 5 days. There were no differences between HA- and HES-treated trauma patients. Protein C and protein S also did not differ between HA- and HES-treatments. At baseline, TM plasma concentrations were increased to > 40 micrograms litre-1 in both sepsis groups only. In the HA-sepsis group, TM increased significantly (from 48.1 (SD 13.9) to 68.4 (13.0) micrograms litre-1), whereas it remained almost unchanged in the HES-sepsis group. In HES-sepsis patients, protein C (from 51.0 (10.1) to 71.9 (8.9)%) and protein S (from 19.0 (6.0) to 40.8 (11.4)%) increased significantly during the study, whereas both remained reduced in HA-patients. TAT (indicating intravascular coagulation) did not differ between the two fluid groups. We conclude that in trauma patients, the type of volume therapy had no influence on the TM-protein C-protein S system. In sepsis patients, volume therapy with HES was beneficial, whereas infusion of HA had no substantial positive effect on endothelial-associated coagulation.
内皮细胞通过产生血栓调节蛋白（TM）等物质，在止血调节中发挥重要作用。在一项前瞻性随机研究中，研究了用不同类型液体进行长期容量替代对TM-蛋白C-蛋白S系统的影响。30例创伤患者和30例大手术后发生脓毒症的患者接受了为期5天的10%低分子（LMW）羟乙基淀粉溶液（创伤组用HES，n = 15；脓毒症组用HES，n = 15）或20%人白蛋白（创伤组用HA，n = 15；脓毒症组用HA，n = 15）治疗，以维持中心静脉压（CVP）在12至16 mmHg之间。在重症监护病房入院当天或脓毒症诊断当天及随后5天采集的动脉血样本中，测量TM、蛋白C、（游离）蛋白S和凝血酶-抗凝血酶（TAT）的血浆浓度。接受HA和HES治疗的创伤患者之间没有差异。HA和HES治疗之间的蛋白C和蛋白S也没有差异。在基线时，仅在两个脓毒症组中，TM血浆浓度升高至>40微克/升。在HA-脓毒症组中，TM显著升高（从48.1（标准差13.9）升至68.4（13.0）微克/升），而在HES-脓毒症组中几乎保持不变。在HES-脓毒症患者中，研究期间蛋白C（从51.0（10.1）%升至71.9（8.9）%）和蛋白S（从19.0（6.0）%升至40.8（11.4）%）显著增加，而在HA患者中两者均保持降低。TAT（表明血管内凝血）在两组液体治疗之间没有差异。我们得出结论，在创伤患者中，容量治疗类型对TM-蛋白C-蛋白S系统没有影响。在脓毒症患者中，用HES进行容量治疗是有益的，而输注HA对内皮相关凝血没有实质性的积极作用。
