The effects of perioperatively administered colloids and crystalloids on primary platelet-mediated hemostasis and clot formation
The effects of perioperatively administered colloids and crystalloids on primary platelet-mediated hemostasis and clot formation
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DOI：
10.1097/00000539-200210000-00012
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发表时间：
2002-10-01
影响因子：
5.7
通讯作者：
Schobersberger, W
中科院分区：
文献类型：
--
作者：
Innerhofer, P;Fries, D;Schobersberger, W
为了探讨常规给予的胶体和晶体是否影响止血系统，我们研究了 60 名接受膝关节置换手术的患者，在随机血管内补液期间，除了基础输注乳酸林格氏液 (RL) 或仅使用 RL 外，还使用 6% 羟乙基淀粉 200/0.5 (HES) 或 4% 改性明胶 (GEL)。除了常规凝血测试外，还进行了凝血因子的测量。此外，使用血小板功能分析仪 (PFA-100(R)) 和 ROTEG(R) 分析（ROTEG(R) 进行体外出血时间的功能测量；外在和内在 [Ex; In] 凝血时间的激活测量，CT [s]；凝块形成时间，CFT [s]；凝块强度，A20 [mm]；凝块的纤维蛋白原成分，FibA20 [mm]；以及最大凝块弹性）被使用。通过重复测量方差分析（所有组合并）来分析变量的时间依赖性；通过比较计算的曲线下面积（AUC（A-D））来检测组之间的差异。对于除 ExCT、ExCFT 和 InCFT 之外的所有变量，都证明了显着的时间依赖性，表明静脉输液时血小板介导的止血和凝块形成受损。胶体组的总凝块强度、纤维蛋白原部分和凝块弹性比 RL 组显着下降（InA20：HES，- 13.0 mm；GEL，- 11.5 mm；RL，- 1.3 mm；P = 0.042；FibA20：HES，- 10.5 mm；GEL，-6.0 mm；RL，-1.3 mm：P < 0.0001；尼斯：HES，-48；RL，-15.8；与 HES 相比，GEL 的纤连蛋白浓度下降明显较小，而两种胶体均观察到纤维蛋白原浓度下降幅度较大的微弱趋势。结果表明，与单独使用 RL 相比，给予胶体对最终血块强度的降低更大，这也对凝血系统产生了影响，尽管影响较小。总凝块强度的降低是由于纤维蛋白原聚合受损，导致凝块的纤维蛋白原部分减少和凝块弹性降低。
To explore whether routinely administered colloids and crystalloids influence the hemostatic system, we studied 60 patients undergoing knee replacement surgery during randomized intravascular fluid administration using 6% hydroxyethyl starch 200/0.5 (HES) or 4% modified gelatin (GEL) in addition to a basal infusion of lactated Ringer's solution (RL), or exclusively RL. In addition to routine coagulation tests, measurements of coagulation factors were performed. Also, functional measurements of the in vitro bleeding time by use of the platelet function analyzer (PFA-100(R)) and ROTEG(R) analysis (ROTEG(R); extrinsically and intrinsically [Ex; In] activated measurements of clotting time, CT [s]; clot formation time, CFT [s]; clot strength, A20 [mm]; fibrinogen component of the clot, FibA20 [mm]; and maximal clot elasticity) were used. Time dependency of variables was analyzed with a repeated-measures analysis of variance (all groups pooled); differences between groups were detected by comparing the calculated area under the curve (AUC(A-D)). For all variables, except ExCT, ExCFT, and InCFT, a significant time dependency was demonstrated, indicating that impaired platelet-mediated hemostasis and clot formation occurred with IV administration of fluids. Total clot strength, fibrinogen part, and clot elasticity decreased significantly more in the colloid groups than in the RL group (InA20: HES, - 13.0 mm; GEL, - 11.5 mm; RL, - 1.3 mm; P = 0.042; FibA20: HES, - 10.5 mm; GEL, -6.0 mm; RL, -1.3 mm: P < 0.0001; NICE: HES, -48; GEL, -35; RL, -15.8; P < 0.0001). The decrease in fibronectin concentrations was significantly smaller with GEL as compared with HES, whereas a weak trend toward a larger decrease in fibrinogen concentrations was observed with both colloids. Results show that colloid administration reduces final clot strength more than does RL alone, which also exhibited effects, albeit minor, on the coagulation system. The reduction in total clot strength was due to impaired fibrinogen polymerization, resulting in a decreased fibrinogen part of the clot and reduced clot elasticity.