중화상환자에서 6% Hydroxyethyl Starch Solution 투여가 혈액 응고 기능에 미치는 영향
Effect of 6% Hydroxyethyl Starch Solution on Coagulation Function in Patients with Major Burns
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Background: Patients with major burns require replacement of intravascular volume. Hydroxyethyl starch (HES) solutions are widely used to replace intravascular volume. Dilution with crystalloids or colloids and corresponding platelet dysfunction are known causes of perioperative bleeding tendencies. The aim of the current study was to evaluate the effect of crystalloid and colloid solutions on platelet function in patients with major burns. Methods: Forty patients scheduled for burn surgery were divided into 4 groups. The infusion was started with a Hartman solution infusion (group 1) from 7 A.M. until surgery. HES (6%, Voluven(R)) was infused in the following concentrations: 7 ml/kg (group 2), 10 ml/kg (group 3), and 15 ml/kg (group 4). The bleeding time (BT), prothrombin time (PT), prothrombin time international ratio (PT INR), activated partial thromboplastin time (aPTT), hemoglobin (Hb), platelet function analyzer-100 closing time (PFA CT), and platelet count (Plt) were measured. Results: Hartmann solution and HES had no significant effect on the BT, PT, PT INR, a PTT, Hb, and Plt. The post-operative PFA CT was significantly higher in group 4 than in group 3. In group 4, the PFA CT was significantly higher post-operatively compared to pre-operatively. Conclusions: The use of high dose HES may increase the risk of bleeding tendencies in burn patients.
Abstract
Background: Patients with major burns require replacement of intravascular volume. Hydroxyethyl starch (HES) solutions are widely used to replace intravascular volume. Dilution with crystalloids or colloids and corresponding platelet dysfunction are known causes of perioperative bleeding tendencies. The aim of the current study was to evaluate the effect of crystalloid and colloid solutions on platelet function in patients with major burns. Methods: Forty patients scheduled for burn surgery were divided into 4 groups. The infusion was started with a Hartman solution infusion (group 1) from 7 A.M. until surgery. HES (6%, Voluven(R)) was infused in the following concentrations: 7 ml/kg (group 2), 10 ml/kg (group 3), and 15 ml/kg (group 4). The bleeding time (BT), prothrombin time (PT), prothrombin time international ratio (PT INR), activated partial thromboplastin time (aPTT), hemoglobin (Hb), platelet function analyzer-100 closing time (PFA CT), and platelet count (Plt) were measured. Results: Hartmann solution and HES had no significant effect on the BT, PT, PT INR, a PTT, Hb, and Plt. The post-operative PFA CT was significantly higher in group 4 than in group 3. In group 4, the PFA CT was significantly higher post-operatively compared to pre-operatively. Conclusions: The use of high dose HES may increase the risk of bleeding tendencies in burn patients.
참고문헌 (18)
- Umlas J, "In vivo platelet function following cardiopulmonary bypass", Transfusion, 15, pp.596~599 (1977)
- Wilmore DW, "Metabolic response to severe surgical illness:overview", World J Surg, 24, pp.705~711 (2000)
- Sparkes BG, "Immunological responses to thermal injury", Burns, 23, pp.106~113 (1997)
- Gallandathuet RC, "A novel hydroxyethyl starch (Voluven) for effective perioperative plasma volume substitution in cardiac surgery", Can J Anaesth, 47, pp.1207~1215 (2000)
- Haljamäae H, "Volume substitution in shock", Acta Anaesthesiol Scand Suppl, 98, pp.25~28 (1993)
- Funk W, "Microcirculatory perfusion during volume therapy. A comparative study using crystalloid or colloid in awake animals", Aneathesiology, 82, pp.975~982 (1995)
- Wang P, "Hemorrhage produces depression in microvascular blood flow which persist despite fluid resuscitation", Circ Shock, 32, pp.307~318 (1990)
- Kjellgren P, "Volume replacement during cardiac surgery-influence on microcirculation", Acta Anaesthesiol Scand, 39, pp.709~710 (1995)
- Francis J, "Can the platelet function analyzer (PFA)-100 test subsititute for the template bleeding time in routine clinical practice", Platelets, 10, pp.132~136 (1999)
- Sirtl C, "Tissue deposits of hydroxy ethyl starch (HES): dose-dependent and time-related", Br J Anaesth, 82, pp.510~515 (1999)
- James MF, "Plasma volume changes associated with two hydroxiethyl starch colloids following acute hypovolemia in volunteers", Anaesthesia, 59, pp.738~742 (2004)
- Boldt J, "Effect of a new modified, balanced hydroxyethyi starch preparation (Hextend) on measures of coagulation", Br J Anaesth, 89, pp.722~728 (2002)
- Entholzner EK, "Coagulation effects of recently developed hydroxyethyl (HES 130", 0.4) compared to hydroxylethyl starches with higher molecular weight, 2000, pp.44, 1116~1121
- Franz A, "The effect of hydroxyethyl starches of varying molecular weights on platelet function", Anesth Analg, 92, pp.1402~1407 (2001)
- Langeron O, "Voluven, a lower substituted novel hydroxyethyl starch (HES 130", 0.4), case fewer effects on coaulation in major orthopedic surgery than HES 200, Anesth Analg, pp.2001, 92[DOI]
- Haisch G, "Influence of a new hydroethylstarch preparation (HES 130", 0.4) on coagulation in cardiac surgical patients, 2001, pp.15, 316~321
- Jamnicki M, "Low-and medium-molecular-weight hydroxyethyl starches", Anesthesiology, 93, pp.1231~1237 (2000)
- Alexander B, "Coagulation, hemostasis, and plasma expanders: a quarter century enigma", Fed Proc, 34, pp.1429~1440 (1975)