Objective To investigate the effect of preoperative volume loading with 6％ hydroxyethyl starch (HFS) 130/0. 4 solutions on hemorheology in geriatric patients undergoing hip replacement during perioprative period. Methods Forty geriatric patients undergoing elective hip replacement surgery were randomly assigned to receive either 10 mL · kg-1 HES solutions (HFS group,20 patients) or 10 mL · kg-1 Ringer's lactate solutions (RL group,patients) over a 30-minute period before surgery (loading infusion,LI). Fifteen healthy subjects were selected as normal control group. Blood samples were taken for determination of hemorheological variables before LI (T0,baseline),immediately after LI (T1), 1 hour after LI (T2) and 1 h after surgery (T3). Results Compared with the control,the blood viscosity, plasma viscosity, erythrocyte aggregation index (EAI) and fibrinogen (FIB) were significantly increased by preoperative volume loading. In HES group, the blood viscosity, plasma viscosity, EAI, fibrinogen and hematocrit (HCT) significantly decreased at T1,T2 and T3, compared with the values at T0(all P＜0.05).In RL group,the blood viscosity at low shear rates and EAI obviously increased at T3 and the blood viscosity,plasma viscosity, EAI, FIB and HCT markedly decreased at T1, compared with the values at T0 (P＜0.05). Compared with RL group,the blood viscosity,plasma viscosity,EAI,FIB and HCT significantly decreased in HES group at T2 and T3(P＜0.05). Conclusion Geriatric patients undergoing hip replacement present hyperviscosity. Preoperative volume loading with 6％ HES solutions can ameliorate hemorheological variables and alleviate hyperviscosity, and therefore may have clinical significance in the prevention of deep venous thrombosis.%目的 观察6%羟乙基淀粉130/0.4溶液(6%hydroxyethyl starch,HES)术前扩容对老年髋关节置换术患者围术期血液流变学的影响.方法 择期行髋关节置换术患者40例,按随机数字表法分为2组,每组20例.手术开始前30 min内给2组患者分别输注10 mL·kg-1HES溶液(HES组)或乳酸钠林格(Ringer's lactated,RL)溶液(RL组).2组于麻醉诱导前(T0)、扩容结束后即刻(T1)、扩容结束后1 h(T2)、手术结束后1 h(T3)抽取静脉血,同时选15例行健康体检者作为正常对照(对照组).采用全功能自动血液流变仪检测3组全血黏度、血浆黏度、红细胞聚集指数(EAI)、纤维蛋白原(FIB)、红细胞压积(HCT).结果 与对照组比较,HES组、RL组的全血黏度、血浆黏度、EAI、FIB均增加(P＜0.05).与T0比较,HES组T1、T2和T3时全血黏度、血浆黏度、EAI、FIB、HCT降低(P＜0.05);与T0比较,RL组T1时全血黏度、血浆黏度、EAI、FIB、HCT降低(P＜0.05),T3时全血低切黏度、红细胞聚集指数增加(P＜0.05).与RL组比较,HES组T2和T3时全血黏度、EAI、FIB、HCT降低(P＜0.05).结论 髋关节置换术的老年患者血液处于高黏状态,术前采用6%羟乙基淀粉130/0.4溶液扩容能明显改善其围术期血液流变学状态,这对防止术后深静脉血栓形成有一定意义.
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