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目的观察右旋糖酐40和羟乙基淀粉130/0.4(HES 130/0.4)对失血性休克患者早期血流动力学、血液流变学及凝血功能的影响,探讨治疗失血性休克早期的首选胶体。方法将2012年1月-2013年12月期间就诊于我院急诊科的76例失血性休克患者随机分为对照组与观察组。在常规急救措施及静脉快速输入1 000 mL林格液同时,对照组和观察组分别在30min内给予15 mL·kg~(-1)的6%右旋糖酐40和6%HES 130/0.4,观察并比较2组患者治疗后30、60 min血流动力学指标、血液流变学指标及凝血功能指标的动态变化。结果与对照组比较,观察组治疗后60 min心率明显降低,而收缩压及平均动脉压均明显升高;治疗后30、60 min高、中、低切全血黏度均明显升高;治疗后30、60 min血浆凝血酶原时间和部分活化凝血活酶时间均明显延长,血浆纤维蛋白原含量明显降低(P均<0.05)。结论 HES 130/0.4可明显改善失血性休克患者早期血流动力学和血液流变学,而对患者血液凝血功能无显著影响,是治疗早期失血性休克较好的人工胶体。
Objective To observe the effects of dextran 40 and hydroxyethyl starch 130 / 0.4 (HES 130 / 0.4) on early hemodynamics, hemorheology and coagulation in patients with hemorrhagic shock and to explore the best colloid for the treatment of early hemorrhagic shock. Methods Seventy-six patients with hemorrhagic shock who were treated in our emergency department from January 2012 to December 2013 were randomly divided into control group and observation group. Simultaneously with the routine first-aid and intravenous infusion of 1 000 mL of Ringer’s solution, the control group and the observation group received 15 mL · kg -1 of 6% dextran 40 and 6% HES 130 / 0.4 respectively within 30 min. The dynamic changes of hemodynamics, hemorheology and coagulation indexes were compared between two groups at 30 and 60 minutes after treatment. Results Compared with the control group, the heart rate of the observation group decreased significantly 60 min after the treatment, and the systolic and mean arterial pressure were significantly increased. At 30 and 60 min after treatment, the whole blood viscosity of the high, middle and low cut significantly increased. After treatment Prothrombin time and partial activated thromboplastin time were significantly prolonged at 30 and 60 min, plasma fibrinogen levels were significantly decreased (all P <0.05). Conclusion HES 130 / 0.4 can significantly improve early hemodynamics and hemorheology in patients with hemorrhagic shock, but has no significant effect on the blood coagulation function in patients with hemorrhagic shock. It is a good artificial colloid in the treatment of early hemorrhagic shock.