羟乙基淀粉超容血液稀释对老年患者肾功能的影响

The effects of acute hypervolemic hemodilution on renal function of patients undergoing scheduled gastrointestinal surgery

目的:探讨术前用6%羟乙基淀粉130/0.5(6%HES130/0.5)行急性超容血液稀释(AHH)对胃肠择期手术患者肾功能的影响。方法:随机将120例择期胃肠手术患者分成三组:H组和B组分别用6%HES130/0.5、血液术前扩容;R组输注复方乳酸钠作为对照。均采用静吸复合麻醉。检测输注前后的血尿素氮(BUN)、肌酐(Cr)和血、尿视黄醇结合蛋自(sRBP,uRBP)。结果:三组BUN、Cr、sRBP、输液量、尿量、出血引流量、尿比重等指标手术前后无明显变化;三组uRBP呈上升趋势,B组T1时uRBP高于T0时(P<0.05),且高于H组和R组(P<0.05)。结论:AHH不影响老年患者肾功能。6%HES130/0.5扩容效果优良,可安全用于老年患者。

Objective：To investigate the effects of acute hypervolemic hemodilution （AHH） with different liquids on renal function in patients undergoing scheduled gastrointestinal surgery. Methods： 120 patients of ASA Ⅰ-Ⅱ, who were to undergo elective operation of gastric cancer or rectum cancer, were divided into three groups in random： H group （HES group）, B group （blood group）, and R group （Ringers Solution group）. H group and B group were infused HES to make acute hypervolemic hemodilution. Results：BUN, Scr and volume of urine were all in the normal range and had no differences in the intergroup comparisons and the within group comparison; RBP： sRBP was always in the normal range, but there was an increasing trends in three groups on uRBP ; There was difference between To and T1 in H group, but there was no statistical signifi- cance in the intergroup comparisons and the within group comparison. Conclusion;AHH had no effect on the stability of renal function. This study confirms that the new generation of artificial colloid HES can effectively maintain the hemodynamic in the state of stable. Its volume expansion effect and maintaining time is similar to Blood and is more reliable than that of crystalloidal fluid. Therefore, AHH may be applied as a feasible, safe and effective method of saving blood in major surgery.