The Effects Of HES On Hemorheology And Coagulation In Patients With Chronic Liver Disease

Background and Objective Mortality from liver disease has doubled in the last three decades, and become the fifth major cause of death for men in the productive ages from 25 to 64 years. More patients with liver disease are presenting for anesthesia and surgery than ever before and, with the advent of liver transplantation, an even greater number may be expected in the future. During the operation, hemorrhage was the most familiar complication that leads to the death of patients with chronic liver disease, and the allogeneic(homologous) blood transfusion was inevitable before. It's widely proved that, hemodiution can reduces the risk of allogeneic blood transfusion and improve the hemorheological condition at the same time. Hydroxyethyl-starch, which is frequently used in clinic, could have some interruption on coagulation, according to the degree of dilution. The objective of our research is to investigate the effects of hemodilution with HES on hemorheology and coagulation in patients with chronic liver disease.Methods 21 healthy volunteers were selected as the control group (Group C) , and 21 patients with chronic liver disease as study group(Group S). Both of the two groups were divided into HSE(n=11) and Ringer's(n= 10) groups. Venous blood of 20ml were collected. 12ml were aliquotted into 4 samples(sample1-4) and dilutedwith 6%HES or Ringer's solution, so that the hematocrit(Hct) was decreased to 30%, 25% or 20%. Rheological parameters, including blood viscosity, plasma viscosity, Hct, index of red blood cell aggregation(ARBC), index of red blood cell rigidity(RRBC), were examined. The rest 8ml of blood were diluted in the same way, parameters about coagulation, including prothrombin time(PT), PT%, activated partial thromboplastin time(APTT),thrombin time(TT) and Fribinogen concentration(FbgC) were examined. Result1, Change of rheological parameters Before hemodilution, the Hct was significantly lower in the study group (PO.05), but plasma viscosity and ARBC were significantly higher. After being diluted by HES, the blood viscosity of study group was shown to be decreased significantly (PO.05), while the ARBC decreased significantly (PO.05), and had not significant difference from that of the control group (P>0.05) when Hct=25% and 20%. The RRBC of control group remain unchanged, while a slightly increase tendency was observed in the study group, but only significantly higher than that of control group (P>0.05) when Hct=20%. After being diluted by R-L, the blood viscosity of both study and control groups were found to be decreased more significantly than that of the HES group (PO.05), but ARBC and RRBC higher.2, Change of coagulation parameters Before hemodilution, the PT was significantly prolonged in the study group (PO.05), and PT% decreased significantly (PO.05). With increasing dilution with HES, while PT% decreased, PT in study group were prolonged more significantly than that of control group. There was no significant difference between HES group and R-L group.Conclusion The change of ARBC is the most important reason that result in the change of hemorheological state in patients with chronic liver disease.Hemodilution with 6%HES can improve the hemorheological state of patients with chronic liver disease significantly. Coagulation changes are more closely related to the degree of dilution, limited hemodilution with HES showed little interruption on coagulation.