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目的研究羟乙基淀粉200/0.5氯化钠注射液(HS-HES)用于液体复苏,对非脓毒症休克患者血浆渗透压及凝血功能的影响。方法选取入住某医院重症监护室的非脓毒症性休克患者42例,并随机均分为生理盐水(NS)组和HS-HES组,分别采用NS 20 m L/kg、HS-HES 10 m L/kg作液体复苏治疗,分析两组在输注前和输注后1 h、2 h的血浆渗透压、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)的变化。结果 NS组输注前、输注后1 h和2 h均未见对血浆渗透压、INR及APTT有影响(均P>0.05)。HS-HES组输注前、输注后1 h和2 h的血浆渗透压分别为(282±29)mmol/L,(299±19)mmol/L和(290±25)mmol/L;INR分别为1.23±0.12,1.40±0.11和1.32±0.15;APTT分别为(41±9)s,(51±10)s和(46±11)s,输注前后比较,其中输注后1 h的血浆渗透压有升高,INR有增加,APTT有延长(均P<0.05)。HS-HES组在输注后1 h的血浆渗透压、INR、APTT均大于NS组(P<0.05)。结论输注HS-HES能够增加血浆渗透压,同时也会影响患者内外源性凝血系统。
Objective To study the effect of hydroxyethyl starch 200 / 0.5 sodium chloride injection (HS-HES) for fluid resuscitation on plasma osmotic pressure and coagulation function in non-septic shock patients. Methods Forty-two non-septic shock patients admitted to a hospital intensive care unit were randomly divided into two groups: NS group and HS-HES group, NS 20 m L / kg and HS-HES 10 m L / kg as the liquid resuscitation treatment. The changes of plasma osmolality, international normalized ratio (INR) and activated partial thromboplastin time (APTT) before and 1 h and 2 h after infusion were analyzed. Results No significant changes of plasma osmolality, INR and APTT were observed in NS group 1 h and 2 h after infusion (both P> 0.05). The plasma osmolality at 1 h and 2 h after HS infusion was (282 ± 29) mmol / L, (299 ± 19) mmol / L and (290 ± 25) mmol / L before HS infusion in HS-HES group (1.23 ± 0.12,1.40 ± 0.11 and 1.32 ± 0.15 respectively). The APTT was (41 ± 9) s, (51 ± 10) s and (46 ± 11) s respectively. Before and after the infusion, APTT Plasma osmolality increased, INR increased, and APTT prolonged (all P <0.05). The plasma osmotic pressure, INR and APTT of HS-HES group at 1 hour after infusion were higher than those of NS group (P <0.05). Conclusion HS-HES infusion can increase the plasma osmolality, but also affect the patient’s extrinsic coagulation system.