Effects of albumin 5% and artificial colloids on clot formation in small infants
Effects of albumin 5% and artificial colloids on clot formation in small infants
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DOI：
10.1111/j.1365-2044.2007.05186.x
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发表时间：
2007-10-01
期刊：
影响因子：
10.7
通讯作者：
Innerhofer, P.
中科院分区：
文献类型：
--
作者：
Haas, T.;Preinreich, A.;Innerhofer, P.
白蛋白在教科书中经常被引用为儿科液体补充的黄金标准，但在实践中，人工胶体更频繁地使用。尽管使用人工胶体的一个问题是它们在止血方面的内在作用，但在儿童中使用6%羟乙基淀粉130/0.4(HES)的现有数据并不确定，也没有关于明胶溶液凝血的数据。随机选择42例(3~15 kg)手术需胶体置换的患儿，分别给予5%白蛋白溶液、4%改良明胶溶液或6%羟乙基淀粉130/0.4溶液15mL.kg(-1)。进行标准凝血试验和改良血栓弹力图(ROTEM)。胶体给药后，尽管明胶和HES使活化的部分凝血活酶时间值增加更多，但所有组的常规凝血试验结果均有显著变化，且差异无统计学意义。在接受白蛋白或明胶治疗的儿童中，凝血时间没有变化，但在所有组中，其他激活的改良血栓弹性图值显着受损。明胶和白蛋白后，中位凝块硬度显着降低，但仍在正常范围内。HES后，凝血时间显著增加，凝块形成时间、α角、凝块硬度和纤维蛋白原/纤维蛋白聚合的损害明显重于白蛋白或明胶，达到低于正常范围的中位数。从止血的角度来看，使用明胶溶液作为白蛋白的替代品可能更可取；HES对整个凝血过程的影响最大。
Albumin is often cited in textbooks as the gold standard for fluid replacement in paediatrics, but in practice artificial colloids are more frequently used. Although one concern with the use of artificial colloids is their intrinsic action on haemostasis, the available data in children are inconclusive for 6% hydroxyethyl starch 130/0.4 (HES) and no data exist for gelatine solution with respect to coagulation. A total of 42 children (3-15 kg) undergoing surgery and needing colloid replacement were randomly assigned to receive 15 ml.kg(-1) of either albumin 5%, 4% modified gelatine solution or 6% hydroxyethyl starch 130/0.4 solution. Standard coagulation tests and modified thrombelastography (ROTEM) were performed. After colloid administration, routine coagulation test results changed significantly and comparably in all groups, although activated partial thromboplastin time values increased more with gelatine and HES. Coagulation time was unchanged in the children who received albumin or gelatine but other activated modified thrombelastography values were significantly impaired in all groups. After gelatine and after albumin the median clot firmness decreased significantly but remained within the normal range. Following HES, coagulation time increased significantly, and clot formation time, alpha angle, clot firmness, and fibrinogen/fibrin polymerisation were significantly more impaired than for albumin or gelatine, reaching median values below the normal range. From a haemostatic point of view it might be preferable to use gelatine solution as an alternative to albumin; HES showed the greatest effects on the overall coagulation process.