国产羟乙基淀粉用于ANH对老年全膝关节置换术患者肾功能的影响

Impact of acute normovolemic hemodilution with domestic hydroxyethyl starch on renal function in elderly patients with total knee arthroplasty

目的探讨国产羟乙基淀粉用于急性等容血液稀释(ANH)对老年全膝关节置换术(TKA)患者肾功能的影响。方法选择80例老年TKA患者,随机分为分为Ⅰ组和Ⅱ组,每组40例。2组均于麻醉诱导后、手术前采集自体血,然后分别静脉输注等体积的国产羟乙基淀粉130/0.4(Ⅰ组)进口羟乙基淀粉130/0.4(Ⅱ组),自体血于术中或术后输注。记录2组围手术期平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)等生命体征指标;检测2组术前、自血回输前、术毕时血红蛋白(Hb)、红细胞比容(Hct)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)及术前、术后1d及术后3d的β2微球蛋白(β2-MG)、血尿素氮(BUN)及血肌酐(Cr)等肾功能指标。结果 1)2组患者自血采集后各时间节点MAP、CVP、HR与自血采集前比较无显著变化,组间比较差异亦不显著(P>0.05)。2)2组自血回输前、术毕时Hb、Hct水平与术前比较均有一定程度下降(P<0.05),尤其在自血回输前有显著下降,但仍在正常范围内。2组间各时点Hb、Hct水平比较无明显差异(P>0.05)。2组自血回输前、术毕时PT、APTT、TT等凝血指标与术前比较无明显变化(P>0.05)。3)2组术后1 d及术后3 d的BUN、Cr及β2-MG水平与术前比较无明显变化(P>0.05)。2组各时点BUN、Cr及β2-MG水平比较无显著差异(P>0.05)。结论国产羟乙基淀粉作为扩容剂应用于ANH,具有稳定的血浆扩充效果,同时对肾脏功能的影响较小,安全性较高。

Objective To explore the impact of acute normovolemic hemodilution with domestic hydroxyethyl starch on renal function in elderly patients with total knee arthroplasty. Methods 80 cases of elderly patients with TKA were randomly divided into Ⅰ group and Ⅱ group, 40 cases in each group. Autologous blood was collected after anesthesia induction and before operation, then were infused with domestic hydroxyethyl starch （ I group） and imported hydroxyethyl starch （ I/ group ） respectively in two groups. The autologous blood was infused back intraoperative and postoperative. The perioperative vital signs such as mean arterial pressure （MAP） , central venous pressure （ CVP）, heart rate （HR） were recorded in two groups. Hemoglobin （ Hb）, hematocrit （ Hot）, RBC, prothrombin time （PT）, activated partial clotting enzyme live time （APTF）, thrombin time （TT） before operation, before autologous blood transfusion, the end of operation were determined in two groups. Blood urea nitrogen （ BUN）, serum creatinine （Cr） and 132-microglobulin （132-MG） before operation, ld and 2d after surgery were determined in two groups. Results Compared with before autologous blood collection, MAP, CVP, HR after autologous blood collection showed no significant changes in two groups （P〉0. 05）, the differences between groups were not significant （P〉 0. 05）. Compared with before operation, Hb and Hct decreased （P〈0. 05） before autologous blood transfusion, the end of operation, and more ob- vious before autologous blood transfusion in two groups, but they were still within the normal range. Hb, Hct showed no sta- tistical difference （P〉0. 05） at each point in time in two groups. PT, APTT, TT before autologous blood transfusion, the end of operation compared with preoperative showed no significant change （P〉0. 05） in two groups. Compared with before operation, the levels of BUN, Cr and 132-MG at ld and 3d after surgery showed no significant changes （P〉0.05） in two groups. The levels of BUN, Cr and β2-MG showed no statistical difference （P〉0. 05） at each time point in two groups. Conelusion Domestic hydroxyethyl starch is the expansion agent used in ANH, has the stable plasma expansion effect, has lit- tle influence on renal function and has high security in elderly patients with TKA.