CAJ | 학술논문

目的比较围术期输注琥珀酰明胶与羟乙基淀粉(130/0.4)对老年病人肾功能的影响.方法择期乳腺手术、甲状腺手术病人40例,随机分为两组,即琥珀酰明胶组(G组)和羟乙基淀粉组(V组);G组自切皮开始输入20 ml/kg的琥珀酰明胶,V组则输入20 ml/kg的羟乙基淀粉,以醋酸林格氏液补充其余体液体需要量,术后第1天和第2天,继续分别输入20ml/kg·天的琥珀酰明胶和羟乙基淀粉.记录麻醉前(T0)、术毕(T1)、术毕5小时(T2)、术后第1天(T3)、第2天(T4)以及第3天(T5)各时点的心率、平均动脉压、CVP值,测定以上各点血肌酐(Cr),血、尿α1微球蛋白(α1-M)、视黄醇结合蛋白(RBP)浓度.结果两组患者生命体征、血Cr浓度在各个时点差异均无显著性(P＞0.05);两组患者血α1-M浓度在各个时点差异亦无显著性(P＞0.05),但较正常值(10～30mg/L)有升高;尿α1-M、尿RBP浓度在手术开始后进行性升高,T2～T5与T0比较,差异有显著性(P＜0.05);而在T2～T5的4个时点上,V组较G组升高的幅度更大,差异有显著性(P＜0.05).结论通过对肾功能敏感指标的监测表明,羟乙基淀粉相对于琥珀酰明胶,其对肾功能影响更大,而且主要是影响了肾小管的功能.
목적 비교위술기수주호박선명효여간을기정분(130/0.4)대노년병인신공능적영향.방법 택기유선수술、갑상선수술병인40례,수궤분위량조,즉호박선명효조(G조)화간을기정분조(V조);G조자절피개시수입20 ml/kg적호박선명효,V조칙수입20 ml/kg적간을기정분,이작산림격씨액보충기여체액체수요량,술후제1천화제2천,계속분별수입20ml/kg·천적호박선명효화간을기정분.기록마취전(T0)、술필(T1)、술필5소시(T2)、술후제1천(T3)、제2천(T4)이급제3천(T5)각시점적심솔、평균동맥압、CVP치,측정이상각점혈기항(Cr),혈、뇨α1미구단백(α1-M)、시황순결합단백(RBP)농도.결과 량조환자생명체정、혈Cr농도재각개시점차이균무현저성(P＞0.05);량조환자혈α1-M농도재각개시점차이역무현저성(P＞0.05),단교정상치(10～30mg/L)유승고;뇨α1-M、뇨RBP농도재수술개시후진행성승고,T2～T5여T0비교,차이유현저성(P＜0.05);이재T2～T5적4개시점상,V조교G조승고적폭도경대,차이유현저성(P＜0.05).결론 통과대신공능민감지표적감측표명,간을기정분상대우호박선명효,기대신공능영향경대,이차주요시영향료신소관적공능.
Objective To compare the influence of succinylated gelatin and hydroxyethyl starch(130/0.4) on renal function in the elderly during perioperative period. Methods Forty patients undering breast operation and thyroid operation were randomly equally divided into G group and V group. 20starch; and supplemented the rest essential liquid with acetated Ringer's solution. On the first and second postoperative day, the same Gelofusine was infused in G group, and the V group with the same hydroxyethyl starch. HR, MAP, CVP, serum creatinine(Cr), hematological α 1-microglobulin, urinary α1-microglobulin and retinol-binding protein(RBP) were measured before anesthesia(T0), at the end of operation(T1), 5 hours after operation(T2), on the first(T3), second(T4) and third(Ts) postoperative day. Results Vital sign and Cr were normal in both groups. The level of hematological α1-microglobulin was higher than normal, but had no significant difference between G group and V group. The level of urinary α1-microglobulin and retinolbinding protein(RBP) in both groups increased significantly at T2 ～ T5 as compared with T1; and the level of these two parameters in V group were significantly higher than G group at T2 ～ T5. Conclusion This study show that, compare with succinylated gelatin, hydroxyethyl starch has more influence on renal function, especially on renal tubule, in the elderly.