目的:探讨羟乙基淀粉HES130/0.4预扩容对颅脑外伤患者围术期血流动力学及凝血功能的影响.方法:选择40例颅脑外伤需手术治疗的成年患者,随机分为羟乙基淀粉HES130/0.4(观察)组和平衡盐液组.分别在麻醉诱导前20min给予500ml的羟乙基淀粉HES130/0.4和1000ml平衡液,在预扩容前(T0)及预扩容后10 min(T1)、20 min(T2)和颅骨板切开后1 min(T3)、10 min(T4)抽取非输液侧的静脉血2ml用于测定血红蛋白(Hb)、红细胞压积(HCT),计算血容量(BV)、液体潴留量(FR)及容量扩张效率(VEE),并观察血液动力学的变化;在术前,预扩容完成时及术毕3个时点抽取静脉血样测定凝血酶原时间(PT),部分激活的凝血酶原时间(APTT),纤维蛋白原(FIB),D-二聚体及凝血因子Ⅷ活性.结果:预扩容完成后,两组的血流动力学参数比较无显著性差异 (P<0.05);颅骨板切开后1 min、10 min的血流动力学参数观察组明显优于平衡盐液组 (P<0.05);预扩容后20min,留在血管内的液体百分比对照组平均只有41.7%,而观察组为91.2%;两组患者术毕时纤维蛋白原(FIB)值下降同时伴有D-二聚体升高,但两组各时点凝血功能各指标无显著性差异.结论:急诊颅脑外伤患者麻醉前应用500ml羟乙基淀粉HES130/0.4预扩容可维持麻醉诱导及颅骨板切除时的血流动力学稳定,并且对颅脑外伤患者凝血功能无严重影响.%Objective :To investigate the effect of volume expansion with Hydroxyethyl Starch 130/0.4 Solution on perioperative hemodynamics and coagulation function in patients with traumatic brain injury.Methods : 40 patients with head injury required surgery were randomly divided into two groups with 20 cases.each. 1000ml lactated Ringer' s solution (LR) was administered during 20min before general anesthesia in control group, and 500ml 6％hydroxyethylstarch (HES) in study group (HES group). Coagulation studies were performed before the induction of anesthesia, after infusion of 6％HES or the lactated Ringer's solution(LR)and the end of surgery. Sample were drawn for the measurements of blood prothrombin time (PT),activated part of the Prothrombin time (APTT ), Fibrinogen(FIB), D-dimer , coagulation factor Ⅷ ( FⅧ :C) and blood platelets. Mean arterial blood pressure (MAP), heart rate (HR) and central venous pressure (CVP) were measured and arterial blood gas analysis was performed at the following time points: immediately before anesthesia, just 10 min, 20min after anesthesia, 1min, 10min after craniotomy. The MAP, HR,CVP were compared. Results : The MAP, HR,CVP of the HES group in 1 min , 10 min after craniotomy were significantly better than those in the control group; in both groups , the value offibrinogen (FIB) were decreased accompanied by D-dimer (D-dimer, DD) increased when the end of surgery. Conclusion : Compared with 1000ml lactated Ringer's solution (LR), rapid plasma volume expansion with 500ml hydroxyethyl starch 130/0. 4 Solution before anesthesia could maintain better blood hemodynamics in patients with acute traumatic brain injury , but it are suggested to further study effect on perioperative coagulation function with Hydroxyethyl Starch 130/0. 4 Solution.
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