羟乙基淀粉130-0.4血液稀释对断指再植患者血液流变学及微循环.docVIP

羟乙基淀粉130/0.4血液稀释对断指再植患者血液流变学及微循环 　 作者：牛纪元，姚立农，孙绪德，张晓峰，杨永慧，刘晓峰，柴伟 【关键词】 血液稀释 Effect of acute hypervolemic hemodilution with hydroxyethyl starch 130/0.4 on hemorheology and microcirculation in patients with finger replantation 　　【Abstract】　AIM: To observe the changes of hemorheology and microcirculation in patients with finger replantation after acute hypervolemic hemodilution (AHHD) using hydroxyethyl starch(HES, 130/0.4). METHODS: Forty patients(ASAⅠⅡ) were randomly divided into 2 groups (n=20 per group) and received intravenous infusion of HES (130/0.4) and Ringers solution before operation to make Hct decrease to 30% . Anaesthetic method was continuous interscalene brachial plexus block. During operation, only Ringers solution was used. After vascular anastomosis and blood reflowing, the microcirculation was observed and compared in the 2 groups and hemorheology index was measured before and after operation. RESULTS: The whole blood viscosity, Hct, capillary filling time and platelet aggregation rate margin in HES (130/0.4) group were significantly less than those in the control group (Plt;0.05) . SPO2 was higher than that in Ringers solution group (Plt;0.05). CONCLUSION: AHHD with HES (130/0.4) can effectively maintain a stable hemodynamic status, improve the perfusion of microcirculation and local oxygen supply and promote the success rate of finger replantation. 　　【Keywords】 hetastarch 130/0.4; hemodilution; replantation; fingers; hemorheology ; microcirculation 　　【摘要】 目的： 探讨羟乙基淀粉130/0.4高容量血液稀释对断指再植患者血液流变学和微循环的影响. 方法： 对40例ASA Ⅰ~Ⅱ患者随机分为万汶组(n=20)和对照组即平衡盐组(n=20),手术前扩容至Hct 30%. 麻醉方法均为肌间沟臂丛神经阻滞. 术中液体维持用平衡盐. 血管吻合开放血流后比较两组血运微循环情况,手术开始时和结束时检测血液流变学指标. 结果： 万汶组AHHD后全血低切黏度、高切黏度、红细胞比容、血小板黏附率明显低于对照组(Plt;0.05)；血管吻合后微循环指标万汶组的毛细血管充盈时间明显低于对照组,SPO2高于对照组(Plt;0.05). 结论： 羟乙基淀粉130/0.4术前AHHD可以明显改善血液流变学状态，有利于微循环灌注,改善局部氧供，提高术中断指再植的成活. 　　【关键词】 羟乙基淀粉130/0.4；血液稀释；再植术；指；血液流变学；微循环 　　0引言 　　新型60 g/L羟乙基淀粉(HES130/0.4,万汶)是目前容量治疗的有效血浆代用品,具有中分子量低取代级的特性，其高效扩容,以及改善血液流变学的特性促进了临床治疗的应用.断指再植的成活是受多因素影响