Brutocao D, Bratton S L, Thomas J R, Schrader P F, Coles P G, Lynn A M
Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA.
J Cardiothorac Vasc Anesth. 1996 Apr;10(3):348-51. doi: 10.1016/s1053-0770(96)80095-4.
Hetastarch has been studied as a volume expander in adults after cardiopulmonary bypass (CPB) and in recommended dosages has not altered coagulation studies or increased clinical bleeding. Hetastarch was compared with albumin in children after CPB to determine whether hetastarch use was associated with increased clinical bleeding or alteration of coagulation studies.
Randomized double-blinded study.
University-affiliated children's hospital.
Forty-seven children age 1 year or greater (mean 72.8 months; range 12 months to 15.5 years) scheduled for repair of congenital heart disease with moderate hypothermia were randomized to receive hetastarch or albumin as a postoperative volume expander during the first 24 hours after surgery.
Thirty-eight children required colloid replacement therapy. Blood pressure, central venous pressure, urine output, and chest tube drainage were used to determine colloid requirement.
Clinical bleeding and laboratory studies of coagulation were evaluated as were requirements for colloid, crystalloid, and blood products. Twenty children received 6% hetastarch, and 18 received 5% albumin. No differences were found in the amount of replacement fluids required, or in coagulation parameters in children receiving 20 mL/kg or less of either colloid replacement therapy. An increase in prothrombin time was demonstrated in children who received greater than 20 mL/kg of 6% hetastarch (p = 0.006); however, no difference in clinical bleeding or blood product requirement was demonstrated between the hetastarch or albumin groups receiving more than 20 mL/kg.
This study demonstrated that 6% hetastarch is safe and an effective plasma volume expander in the postoperative management of children, using volumes up to 20 mL/kg. Close laboratory monitoring and careful evaluation of clinical bleeding are suggested when larger doses of hetastarch are administered because of prolongation of the prothrombin time with more than 20 mL/kg of hetastarch.
羟乙基淀粉已被作为体外循环（CPB）后成人的容量扩充剂进行研究，且推荐剂量并未改变凝血指标或增加临床出血。将羟乙基淀粉与CPB后的儿童白蛋白进行比较，以确定使用羟乙基淀粉是否会增加临床出血或改变凝血指标。
随机双盲研究。
大学附属医院。
47名年龄1岁及以上（平均72.8个月；范围12个月至15.5岁）计划在中度低温下进行先天性心脏病修复的儿童被随机分配，在术后24小时内接受羟乙基淀粉或白蛋白作为术后容量扩充剂。
38名儿童需要胶体替代治疗。使用血压、中心静脉压、尿量和胸管引流量来确定胶体需求量。
评估临床出血和凝血实验室指标，以及胶体、晶体和血液制品的需求量。20名儿童接受6%羟乙基淀粉，18名接受5%白蛋白。接受20 mL/kg或更少胶体替代治疗的儿童，在所需替代液量或凝血参数方面未发现差异。接受超过20 mL/kg 6%羟乙基淀粉的儿童凝血酶原时间延长（p = 0.006）；然而，接受超过20 mL/kg的羟乙基淀粉组和白蛋白组在临床出血或血液制品需求量方面未显示差异。
本研究表明，6%羟乙基淀粉在儿童术后管理中作为血浆容量扩充剂是安全有效的，使用剂量可达20 mL/kg。当给予较大剂量羟乙基淀粉时，建议密切进行实验室监测并仔细评估临床出血情况，因为超过20 mL/kg的羟乙基淀粉会使凝血酶原时间延长。
