羟乙基淀粉130/0.4对非体外循环冠状动脉搭桥术患者肾功能的影响

Influence of hydroxyethyl starch 130/0.4 on renal function of patients undergoing off-pump coronary artery bypass

目的比较非体外循环冠状动脉搭桥术(OPCAB)中临床剂量的羟乙基淀粉(HES)130/0.4和琥珀酰明胶(GEL)对肾功能的影响。方法选择24例美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级、择期行OPCAB的患者,随机均分为GEL组和HES组。分别于麻醉诱导前(T_0)、术毕即刻(T_1)和术后24h(T_2)测定血尿素氮(BUN)和肌酐清除率(Ccr)。记录T_1、T_2时间点尿量。结果两组间术中胶体或晶体补液量、术中出血量、24h胸管引流量以及T_1和T_2时间点尿量的差异均无统计学意义(P值均>0.05)。两组间及各组内T_0、T_1和T_2时间点的BUN和Ccr的差异均无统计学意义(P值均>0.05)。结论临床常规剂量的HES 130/0.4对OPCAB患者肾功能的影响与GEL相比无明显差异。

Objective To compare the influence of hydroxyethyl starch （HES） 130/0. 4 （Voluven） and gelatin（Gelofusine, GEL） on renal function of patients undergoing off-pump coronary artery bypass（OPCAB）. Methods Twenty-four patients undergoing elective OPCAB were randomized into two groups1 GEL group （n = 12）, gelatin was given perioperatively for volume support to keep the central venous pressure（CVP） between 7 and 14 mm Hg（1 mm Hg = 0. 133 kPa）; HES group（n = 12）, HES 130/0. 4 was administered using the same protocol as in GEL group. Measurements of renal function variables were performed before induction of anesthesia （T0）, at the end of surgery（T1 ）, and 24 hours after surgery（T2 ）. The urine output during operation and 24 hours after surgery were recorded. Results The two groups did not differ significantly with regard to perioperative bleeding, accumulative chest tube drainage within 24 hours after surgery or in use of packed red blood cells and infusion of crystalloids or colloids（P all 〉 0.05）. There was no statistical significance in the urinary output at To and T1 between the two groups. Renal function variables such as blood urea nitrogen （BUN） and creatinine clearance rate（Ccr） were also similar in the two groups（P all 〉 0. 05）. Conclusion Volume replacement with HES 130/0.4 is as safe as gelatin with regard tO the renal function in patients undergoing OPCAB.