体外循环中贺斯和佳乐施对凝血功能的影响【临床医学论文】.doc

临床医学论文-体外循环中贺斯和佳乐施对凝血功能的影响 ?????????????????? 作者：钱金兰，李欣，郭震，刁文瑜，徐凌峰，吴金宝，殷凤珍，丁慧萍 【关键词】? 凝血功能 ??? 摘要：目的 探讨6%中分子羟乙基淀粉和4%的琥珀明胶用于体外循环预充时，对患者凝血功能的影响。方法 选择38例瓣膜替换术的患者，随机分为贺斯组和佳乐施组。分别在麻醉前及鱼精蛋白中和后30min取静脉血1ml，运用Sonoclot 凝血及血小板功能分析仪测定凝血功能，测定参数有：激活凝血时间（SonACT）、凝血速率（Clot Rate）、血小板功能（Platelet Function），并描绘凝血过程曲线图。结果 两组间激活凝血时间、血小板功能术前术后均无显着性差异，但术后凝血速率贺斯组明显小于佳乐施组。结论　佳乐施与贺斯1000ml用于预充时对凝血功能无显着影响，但与佳乐施相比，贺斯对凝血通路中纤维蛋白形成速率抑制相对较强。 　　关键词：贺斯；佳乐施；凝血功能；体外循环 　　The Effect of Hydroxyethy Starch and Gelatin on Coagulation in the Operation with Cardiopulmonary Bypass 　　　Abstract: OBJECTIVE? To observe the effect of 6% hydroxyethel starch(HES) and 4% succinylated gelatin(GEL) for priming on coagulation in the operation with cardiopulmonary bypass(CPB). METHODS Thirty-eight patients ondergoing valve replacement were divided randomly into two groups: Group HES and Group GEL. The SonACT, Clot Rate and Platelet Function were measured in the two groups before anaesthesia and 30 minutes after protamine was neutralized using the Sonoclot Analyzer. RESULTS There is no significant difference between these two groups before and after CPB in terms of coagulation data: SonACT and Platelet Function ( P＞0.05), but the clot rate There is no significant effect on coagulation when 1000ml HES and GEL were used for priming,? but the effect of restraining the fibrin formation is stronger in HES. 　　Key words：hydroxyethel starch; Gelofusine; coagulation; Cardiopulmonary Bypass????????????????????????????????????????????????????????????????????????? 　　人工胶体溶液用于体外循环中预充和血液稀释是临床体外循环常规手段，目前常用的人工胶体溶液有6%中分子羟乙基淀粉（6% hydroxyethel starch,200/0.5, Fresenius AG, Germany, HES）――贺斯和4%的琥珀明胶(4% succinylated gelatin, GEL)――佳乐施，对于两者用于体外循环预充选择，争论的焦点部分集中于对凝血功能的影响上。本研究采用Sonoclot 凝血及血小板功能分析仪对比观察6%中分子羟乙基淀粉和4%的琥珀明胶用于体外循环，对患者凝血功能的影响，以对临床人工胶体溶液的选择使用提供参考。 　　1 资料和方法 　　1.1 一般资料?????????????????????????????????????? 　　选择38例体外循环下心脏瓣膜替换术的患者，其中男23例，女15例，年龄21～70岁，体重65～70kg，术前血红蛋白（136±29）g/L，血小板（189.6±94.2）×109/L。术前无肝、肾疾病及凝血机制障碍，血常规、凝血功能各项检查正常，手术前2周未