目的 探讨使用乳酸钠林格注射液（lactated ringer′s solution, RL）、琥珀酰明胶注射液（succinylated gelatin, GEL）、羟乙基淀粉130/0.4氯化钠注射液（hydroxyethyl starch 130/0.4, HES）稀释及应用人纤维蛋白原（human fibrinogen, Fg）、人凝血因子Ⅷ（human coagulation factor Ⅷ, FⅧ）对凝血的影响和纠正作用。 方法 择期行外科手术患者18例，采用随机数字表法将其分为RL组、GEL组、HES组，每组6例。采集静脉血，37 ℃恒温下，每组保留部分全血外，余按分组予相应液体进行50%稀释，并应用不同剂量Fg、FⅧ，使用血栓弹力图（thrombelastography, TEG）［TEG 参数包括凝血反应时间（R值）、血凝块形成时间（K值）、凝固角（α角）、最大振幅（MA值）］分析凝血变化。 结果 RL组中，与全血比较，稀释后血液的 K值延长、MA值减少（P<0.05）。GEL组和HES组中，与同组全血比较，稀释后血液的K值延长、α角和MA值均减小（P<0.05）。HES组血液稀释后的K值大于GEL组，MA值小于GEL组（P<0.05）。RL组中，稀释血液应用小剂量Fg后，与稀释血液比较，K值降低、α角及MA值增大（P<0.05），其中K值及α角偏离正常范围。稀释血液应用大剂量Fg后，K值、α角及MA值都偏离正常范围。GEL组中，稀释血液应用小剂量或大剂量Fg后，与全血比较，TEG参数差异无统计学意义（P>0.05）。HES组中，稀释血液应用小剂量Fg后，与全血比较，R值、K值与α角差异无统计学意义（P>0.05），但MA值仍低于全血时的基础值（P<0.05）。而稀释血液应用大剂量Fg后，与全血比较，TEG各参数差异无统计学意义（P>0.05）。3组稀释血液应用FⅧ后，与稀释血液比较，TEG参数差异无统计学意义（P>0.05）。 结论 RL稀释对凝血的影响最轻，GEL次之，HES影响最明显。Fg对液体稀释引起的凝血功能异常有纠正作用，但其纠正效果与液体种类有关，其中HES对凝血功能的影响需要大剂量Fg才能被完全纠正。FⅧ不能纠正血液稀释造成的凝血功能障碍。
Ｏｂｊｅｃｔｉｖｅ To investigate the effects of in vitro blood dilution with lactated ringer′s solution (RL), succinylated gelatin (GEL) and hydroxyethyl starch 130/0.4 (HES) on coagulopathy in the presence or absence of human fibrinogen (Fg) and human coagulation factor Ⅷ (FⅧ). Methods Blood collected from 18 patients scheduled for elective operations was diluted to 50%, followed by two different dose of Fg and FⅧ supplementation at 37 ℃. The influence was analyzed using TEG ［The TEG variables of reaction time (R), coagulation time (K), growth angle (α) and maximum amplitude (MA) were determined］. Results TEG parameters changed significantly in all three groups after dilution. After dilution, the K values were increased and MA values were decreased in group RL compared to those values in whole blood (P<0.05). Compared with values in whole blood, the K values were increased while α and MA values were decreased in both GEL and HES groups after dilution (P<0.05). The changes of K and MA values in group HES were more profound than those values in group GEL (P<0.05). After supplementation of low dose Fg in group RL, the K values were decreased while α and MA values were increased compared to values after dilution (P<0.05). The K and α values were deviated from normal range. After supplementation of high dose Fg, the K, α and MA values were all deviated from normal range. In group GEL, supplementation of low or high dose Fg can restore TEG parameters after dilution. In group HES, supplementation of low dose Fg partially restored TEG parameters after dilution. The MA values were still lower than those at whole blood (P<0.05). While after supplementation of high dose Fg, all the TEG parameters were restored to the baseline. TEG parameters cannot restore to normal values by FⅧ in all three groups (P>0.05). Conclusions Coagulation function was impaired by all three fluids with HES having the most profound impairment effect. Fg in vitro improved blood dilution induced coagulopathy. The effect of Fg supplementation depende on the kind of fluid. Coagulopathy induced by HES was completely correcterd only through high does Fg substation. Supplementation of FⅧ cannot improve blood dilution induced coagulopathy.
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