Gelatin and hydroxyethyl starch, but not albumin, impair hemostasis after cardiac surgery
Gelatin and hydroxyethyl starch, but not albumin, impair hemostasis after cardiac surgery
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DOI：
10.1213/01.ane.0000200285.20510.b6
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发表时间：
2006-04-01
影响因子：
5.7
通讯作者：
Kuitunen, AH
中科院分区：
文献类型：
--
作者：
Niemi, TT;Suojaranta-Ylinen, RT;Kuitunen, AH
我们研究了45例心脏手术后给药胶体对止血的影响。患者随机接受15 mL kg（-1）的4%白蛋白、4%琥珀酰化明胶或6%羟乙基淀粉（分子量200 kDa/取代度0.5）短期输注。在明胶组和羟乙基淀粉组中，在完成输注后立即进行血栓弹性测量的最大凝块硬度也有类似的下降，而在白蛋白组中这些值保持不变。凝块强度的损害持续到2小时，尽管值部分恢复。在人工胶体的汇总数据中，术后出血与凝块强度呈负相关。与明胶组相比，羟乙基淀粉组对纤维蛋白形成（凝块形成时间、a角）和纤维蛋白原依赖性凝块强度（最大凝块硬度和剪切弹性模量）的干扰更大。我们得出结论，在体外循环手术后，明胶和羟乙基淀粉都会损害凝块强度和纤维蛋白的积累，这可能使患者失血增加。羟乙基淀粉对止血的损害最大，而白蛋白对止血变量的影响最小。
We investigated the effect of postoperative administration of colloids on hemostasis in 45 patients after cardiac surgery. Patients were randomized to receive 15 mL kg(-1) of either 4% albumin, 4% succinylated gelatin, or 6% hydroxyethyl starch (molecular weight of 200 kDa/degree of substitution 0.5) as a short-term infusion. There was a comparable decrease in maximum clot firmness of thromboelastometry tracings in gelatin and hydroxyethyl starch groups immediately after completion of the infusion, whereas these values remained unchanged in the albumin group. The impairment in clot strength persisted up to 2 h, although the values partly recovered. Postoperative bleeding correlated inversely with the clot strength in pooled data of the artificial colloids. Fibrin formation (clot formation time, a-angle) and fibrinogen-dependent clot strength (maximum clot firmness and shear elastic modulus) were more disturbed in the hydroxyethyl starch group than in the gelatin group. We conclude that after cardiopulmonary bypass surgery, both gelatin and hydroxyethyl starch impair clot strength and fibrin buildup, which may predispose patients to increased blood loss. The greatest impairment in hemostasis was seen after hydroxyethyl starch administration, whereas albumin appeared to have the least effect on hemostatic variables.