Effects Of Extracorporeal Blood Dilution On Coagulation And Hemorheology

Objective To compare the effects of in vitro hemodilution with lactated ringer’s solution, hydroxyethyl starch 130/0.4 and gelatin on the blood coagulation function.Methods Blood was taken from 10 healthy young male volunteers. Blood was diluted by 10%,30%, and 50% using either 6% hydroxyethyl starch 130/0.4(Group W),4% gelatin (Group G) and Ringer’s lactate solution(GroupL). Thrombelastograph (TEG) was performed and record reaction time (R time), blood clotting time (K time), alpha angle, maximum amplitude (MA), at the same time conventional coagulation parameters were detected, such as hemoglobin(Hb), prothrombin time (PT), prothrombin time activity (PTA), international normalized ratio (INR), partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB)and whole blood viscosity(WBV).Results R was shortened and MA was increased in L group at 10% dilution(P<0.05).Negative effects on the coagulation system were showed in the Group G and Group W at 30% dilution (P<0.05), but most coagulation parameters were in the normal range. The coagulation function were impaired in all group at 50% dilution(P<0.05).Conclusion Coagulation functions was closely related to the degrees of dilution. At 10% dilution, the three fluids do not significantly affect hemostasis. At 30% dilution hydroxyethyl starch 130/0.4 and gelatin impaired the coagulation system, but the whole coagulation function was intact. At 50% dilution, the hemostasis was impaired greatly in all groups especially hydroxyethyl starch 130/0.4.Objective On the base of in vitro studies in the first party,we observe the effect of blood dilution on coagulation function in clinical environment, and to provide reference for clinical work.Methods We select 80 patients who is ready for valve replacement surgery in our hospital from December 2014 to December 2015.We divided the patients into two groups:Succinylated Gelatin group (G group)and Hydroxyethyl Starch group(W group),and choose the type of Cardiopulmonary Bypass Priming colloid according to the random number table,each group have 40 cases.we collect blood samples in different time point:5min after protamine neutralization,back to intensive care unit,6 hours after back to intensive care unit.Then we do routine blood and clotting four examination.Record CPB time, blocking time, blood, the postoperative blood loss and the type of blood products, serious complications and the other special circumstances.Results There is no significant difference in the comparison of all the results between G group and W group in different time point. We analysis the related factors of bleeding volume in 6 hours using single-factor correlation analysis method,but we can’t find a significant impact factor.Conclusion In clinical practice, there is no difference between different cardiopulmonary bypass prime solution on the coagulation function after operation; For the postoperative coagulation, the way of cardiopulmonary bypass prime we do so far is safe.