CAJ | 학술논문

目的观察两种羟乙基淀粉(hydroxyethyl starch,HES)(万汶和贺斯)急性高容血液稀释(acute hypervolemic hemodilution,AHH)对颅脑外伤急诊手术患者血流动力学及肾功能的影响.方法本研究共纳入54例颅脑外伤急诊手术患者,随机分为万汶( AHH130)组、贺斯(AHH200)组和乳酸林格液(LR)组,每组18例,均采用静吸复合全身麻醉.术中监测心电图(ECG)、平均动脉压(MAP)、中心静脉压(CVP)和脉氧饱和度(SpO2)；检测AHH前(T0)、手术结束时(T1)、术后4 h(T2)、术后第1天(T3)、术后第2天(T4)和术后第3天(T5)时血尿素氮(BUN)、血尿肌酐(BCr、UCr)、尿白蛋白(ALB)和尿α1-微球蛋白( α1 - MG)的变化；计算肌酐清除率(CCr)和钠清除分数(FSC)；记录尿量、补液、失血及输血情况.结果三组HR、CVP、MAP在各时相点的变化均在正常范围内,组间及组内比较差异无统计学意义(P＞0.05).三组术中失血量和尿量差异无统计学意义(P＞0.05),术中补液量和异体血输入量AHH130组和AHH200组明显少于LR组(P＜0.01).三组BUN、BCr和尿ALB在各时相点组间和组内比较差异无统计学意义(P＞0.05).AHH后,AHH130组和AHH200组尿α1 - MG浓度均明显升高(P＜0.01),至T5虽有所下降,但仍明显高于T0水平(P＜0.01),且各时相点尿α1 - MG浓度明显高于LR组(P＜0.05).AHH后AHH130组和AHH200组CCr呈下降趋势,在T2最低,与T0比较差异有统计学意义(P＜0.01)；而后回升,至T5时接近T0水平.各组FSC在AHH后均有轻度升高,T2最明显,但与T0比较差异无统计学意义(P＞0.05).其他各时相点组内和组间比较差异均无统计学意义(P＞0.05).各组各时相点肾功能所有数值均在正常范围内变化.结论 HES(万汶和贺斯)AHH对术前肾功能正常的颅脑外伤急诊手术患者的肾功能均无明显影响,能明显减少异体血输注,是安全可行的血液保护措施.
목적 관찰량충간을기정분(hydroxyethyl starch,HES)(만문화하사)급성고용혈액희석(acute hypervolemic hemodilution,AHH)대로뇌외상급진수술환자혈류동역학급신공능적영향.방법 본연구공납입54례로뇌외상급진수술환자,수궤분위만문( AHH130)조、하사(AHH200)조화유산림격액(LR)조,매조18례,균채용정흡복합전신마취.술중감측심전도(ECG)、평균동맥압(MAP)、중심정맥압(CVP)화맥양포화도(SpO2)；검측AHH전(T0)、수술결속시(T1)、술후4 h(T2)、술후제1천(T3)、술후제2천(T4)화술후제3천(T5)시혈뇨소담(BUN)、혈뇨기항(BCr、UCr)、뇨백단백(ALB)화뇨α1-미구단백( α1 - MG)적변화；계산기항청제솔(CCr)화납청제분수(FSC)；기록뇨량、보액、실혈급수혈정황.결과 삼조HR、CVP、MAP재각시상점적변화균재정상범위내,조간급조내비교차이무통계학의의(P＞0.05).삼조술중실혈량화뇨량차이무통계학의의(P＞0.05),술중보액량화이체혈수입량AHH130조화AHH200조명현소우LR조(P＜0.01).삼조BUN、BCr화뇨ALB재각시상점조간화조내비교차이무통계학의의(P＞0.05).AHH후,AHH130조화AHH200조뇨α1 - MG농도균명현승고(P＜0.01),지T5수유소하강,단잉명현고우T0수평(P＜0.01),차각시상점뇨α1 - MG농도명현고우LR조(P＜0.05).AHH후AHH130조화AHH200조CCr정하강추세,재T2최저,여T0비교차이유통계학의의(P＜0.01)；이후회승,지T5시접근T0수평.각조FSC재AHH후균유경도승고,T2최명현,단여T0비교차이무통계학의의(P＞0.05).기타각시상점조내화조간비교차이균무통계학의의(P＞0.05).각조각시상점신공능소유수치균재정상범위내변화.결론 HES(만문화하사)AHH대술전신공능정상적로뇌외상급진수술환자적신공능균무명현영향,능명현감소이체혈수주,시안전가행적혈액보호조시.
Objective To observe the effect of acute hypervolemic hemodilution (AHH) with two kinds of hydroxyethyl starches including Voluven and HES on the renal function of emergency surgery patients with brain injury.Methods This study involved 54 brain injury patients treated with emergency surgery,who were randomly divided into Voluven group ( AHH130 group),HES group ( AHH200 group) and Ringer's lactate group (LR group),with 18 patients in each group.All the patients were managed with inhalation anesthesia.ECG,MAP,CVP and SpO2 were observed in operation.The blood urea nitrogen (BUN),urine creatinine ( BCr,UCr),urinary albumin (ALB) and urinary α1-microglobulin ( α1-MG) were detected before AHH ( T0 ),at the end of operation ( T1 ),at 4 hours ( T2 ),day 1 ( T3 ),day 2 (T4) and day 3 (T5) after operation.The creatinine clearance (CCr) and fractional sodium clearance (FSC) were calculated and the urine output,fluid replacement,blood loss and blood transfusion recorded.Results The HR,CVP and MAP in the three groups were within the normal range of variation at all time points,with statistical difference for comparison between groups and within group ( P ＞ 0.05 ).There was no significant difference in urine output and blood loss,while the intraoperative fluid volume and blood transfusion in the AHH130 group and the AHH200 group were significantly less than those in the LR group (P ＜ 0.01 ).There was no statistical difference in aspects of BUN,BCr and urinary ALB at each time point between and within the three groups ( P ＞ 0.05 ).After treatment with AHH,the urinary α1-MG level in the AHH130 group and AHH200 group was significantly increased ( P ＜0.01 ),which was decreased at T5 but was still higher than that at T0 ( P ＜ 0.01 ),and was higher than that in the LR group at all time points (P＜0.05).After treatment with AHH,CCr was decreased in the AHH130 group and AHH200 group,which reached the lowest level at T2,with statistical difference compared with the levd at T0 ( P ＜0.01 ).Then,CCr was recovered to normal at T5.FSC in the three groups after AHH treatment was increased slightly and the most significantly at T2,which was not statistically different compared with that at T0 ( P ＞ 0.05) and FSC was not statistically different between and within groups at other time points (P ＞0.05).All the values about the renal function in all the groups changed within the normal range at each time point.Conclusions AHH with Voluven or HAES is a feasible and safe blood conservation measure that can significantly reduce the allogeneic blood transfusion but exert insignificant effect on renal function of the brain injury patients with normal renal function before emergency surgery.