羟乙基淀粉与明胶对体外循环心内直视术病人凝血和肾功能的影响

The effects of hydroxyethyl starch and gelatin on coagulation and renal function in patients undergoing open heart surgery

目的 比较 6%羟乙基淀粉 (HES)与 4 %改良琥珀明胶 (MFG)用作心肺转流 (CPB)预充液及术中容量补充对凝血指标及肾功能的影响。方法 随机选择CPB心内直视术患者 4 0例 ,根据人工心肺机预充液配方分为两组。Ⅰ组 :MFG5 0 0ml +晶体 13 0 0ml;Ⅱ组 :HES5 0 0ml +晶体13 0 0ml。每组晶体均为甘露醇 5ml/kg +碳酸氢钠 2 5ml/kg +复方乳酸钠液。CPB中若容量不足 ,则分别输注MFG和HES ,总量均≤ 2 0ml/kg(包括预充液用量 ) ,超此量时则改用血浆。 结果 ( 1)与术前相比 ,两组患者CPB2 0分钟时WBC均显著下降 (P <0 0 1) ,术毕及术后 18小时WBC均显著上升(P <0 0 1) ,但MFG组高于HES组 (P <0 0 1)。与术前相比 ,两组患者CPB2 0分钟、停机、术毕及术后 18小时RBC、Hb、Hct及Pt均显著下降 (P <0 0 1)。 ( 2 )凝血功能指标组间组内均无差异 (P >0 0 5 )。 ( 3 )术毕时明胶组尿素氮有显著上升 (P <0 0 1)。肌酐值组内组间均无差异 (P >0 0 5 )。结论 HES与MFG均适用于CPB心内直视术病人 ,对凝血指标及肾功能无明显影响 ;但HES组白细胞数的上升较MFG组少 ,炎症反应较轻。

Objective To compare the effects of 6% hydroxyethyl starch (HES) with 4% modified fluid gelatin (MFG) for priming and volume replacement on coagulation and renal function during cardiopulmonary bypass (CPB).Methods Forty patients undergoing open heart surgery were divided randomly into two groups:group Ⅰ,MFG 500ml+crystalloid 1*#300ml; group Ⅱ,HES 500ml+crystalloid 1*#300ml. The contents of crystalloid used in two groups included 20% mannitol 5ml/kg,5% NaHCO 3 2 5ml/kg and balanced solution.In case of supplement of volume during CPB,the total volume of MFG or HES was less than 20ml/kg (including the priming).If the patients needed more colloid,plasma was selected.Results (1)Compared with preoperative value,WBC was decreased at 20 min after CPB ( P< 0 01) and increased at the end of operation and 18h after operation in two groups( P< 0 01).The increase of WBC in group Ⅰ was more than that in group Ⅱ( P< 0 01).Compared with the preoperative,RBC,Hb,Hct and Pt were decreased at 20min after CPB,at the end of CPB and the operation and 18h after operation( P< 0 01).(2)There was no significant difference in coagulation between two groups( P> 0 05).(3)Compared with the preoperative,BUN was significantly increased in group Ⅰ ( P< 0 01),but there was no difference in Cr between two groups( P> 0 05).Conclusion 6% HES or 4% MFG can be used during CPB,without any marked influence on coagulation and renal function.6% HES has less effect on the increase of WBC than 4% MFG.