Abstract
Objective To evaluate the effects of acute hypcrvolemic hemodilution (AHH) with hydroxyethyl starch (HES) 200/0.5 or 130/0.4 on coagulation function in patients with large-area burn injury during perioperative period. Methods Forty ASA Ⅱ patients aged 18-49 yr undergoing early eschar excision surgery were randomly divided into 2 groups (n = 20 each): HES 200/0.5 group (group HES 200) and HES 130/0.4 group (group HES 130). Twenty health volunteers were selected as normal control group (group C). In groups HES 200 and HES 130, HES 15 ml/kg was infused over 30 min at the beginning of induction of anesthesia. Flow cytometry was used to detect the expression of GPⅡb/Ⅲa and CD62P before induction of anesthesia (baseline,T0), immediately after the end of AHH (T1), at 1 h after the end of AHH (T2) and at 1 h after the end of surgery (T3). Thrombelastography (TEG) was used to detect the reaction time (R), clotting time (K), α angle, maximum amplitude (MA) and coagulation index (CI). Results The expression of GPⅡb/Ⅲa and CD62P was up-regulated, R and K were shortened, and α angle, MA and CI were increased in group HES 200 and HES 130 compared with group G (P<0.05). The expression of GPⅡb/Ⅲa and CD62P was up-regulated, R was shortened, and α angle, MA and CI were increased in group HES 130 compared with group HES 200 (P<0.05) . The expression of GPⅡb/Ⅲa and CD62P was down-regulated, R and K were prolonged, and α angle and CI were decreased in group tIES 200 (P<0.05), and R and K were prolonged, and α angle and CI were decreased in group HES 130 as compared to the baseline values at T0(P<0.05). Conclusion AHH with HES 200/0.5 can alleviate hypercoagulable state through inhibitting excessive platelet activation during perioperative period in patients with large-area burn and HES 200/0.5 is better than HES 130/0.4. Key words: Hetastarch; Hemodilution; Burns; Blood platelets; Blood coagulation tests
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