不同胶体液在体外循环中对心脏手术患儿胶体渗透压及凝血功能的影响

　　【摘要】 目的 比较体外循环(CPB)中6%羟乙基淀粉(130/0.4，万汶)和琥珀明胶对心脏手术患儿胶体渗透压和凝血功能的影响。 方法 选择5～10岁 美国麻醉医师协会(ASA)Ⅰ～Ⅱ级、行心内直视手术患儿40例，随机分为观察组(万汶组)和对照组(琥珀明胶组)各20例，测定CPB前血液预充液、CPB 10 min、30 min、CPB结束时的胶体渗透压(COP)，凝血功能指标血小板计数(Plt)、凝血酶原时间(PT)、激活全血凝固时间(ACT)。结果 对照组CPB中COP明显降低，且低于观察组(P<0.01)，PT、ACT无明显性延长。 结论 万汶对小儿凝血功能影响不显著，可安全应用于小儿CPB预充液中。

　　【关键词】 体外循环;胶体渗透压;凝血功能

　　Effect of different colloids on Colloid Osmotic Pressure and

　　Blood Coagulation of Children during Cardiopulmonary Bypass

　　YANG Yan-ming, LI ping, YAN Wen-zheng

　　( Department of Anesthesia,Central 371 Hospital of PLA，Henan Xinxiang 453000，China)

　　Abstract: OBJECTIVE To compare the effect of 6% hydroxyethyl starch solution and succinylated gelatin on colloid osmotic pressure and blood coagulation during cardiopulmonary bypass. METHODS According to Medical Association American Society of Anesthesiologists (ASA) Ⅰ ～ Ⅱ grade, the 40 open hear surgery pediatric cases were randomly divided into observation group and control group, 20 cases of each group. The colloid osmotic pressure (COP), clotting function of platelet count (PLT), prothrombin time (PT) and activated clotting time (ACT) were measured at the blood priming solution before CPB, 10min and 30min after starting CPB, and the end of CPB. RESULTS Compared to observation, the colloid osmotic pressure was significantly decreased in the control group (P<0.01). There was no significant increase in PT and ACT value between two groups. CONCLUSION 6% hydroxyethyl starch solution has no significant impact on the blood coagulation and can add into priming solution in pediatric cardiopulmonary bypass safely.

　　Key words： Cardiopulmonary bypass;Colloid osmotic pressure;Blood coagulation

　　在体外循环(cardiopulmonary bypass，CPB)下行心血管手术时，需要一定量的晶体液和胶体液进行预充，胶体的种类主要为人血白蛋白、新鲜血浆、明胶类代血浆及右旋糖酐等，其中人血白蛋白的血浆半衰期很长，用量不可过多，新鲜冷冻血浆及明胶类代血浆具有传染疾病的潜在危险，随着羟乙基淀粉在临床麻醉中的大量应用，在CPB的预充中也开始采用，我院在小儿心内直视手术中采用6%羟乙基淀粉(130/0.4)行血液稀释，并观察其对凝血功能和胶体渗透压(

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