胶体行急性高容量血液稀释对肾功能的影响  

Effects of acute-hypervolemic hemodilution with colloid on renal function

作　　者：王杨[1] 王天元[2] 

机构地区：[1]哈尔滨医科大学第一临床医学院麻醉科,黑龙江哈尔滨150001 [2]吉林大学中日联谊医院麻醉科,吉林长春130001

出　　处：《哈尔滨医科大学学报》2008年第3期281-283,286,共4页Journal of Harbin Medical University

摘　　要：目的观察输入6％羟乙基淀粉和4％琥珀酰明胶进行急性高容量血液稀释（AHHD）对患者围术期。肾功能的影响。方法30例。肾功能正常，ASAI～Ⅱ级的择期胃肠手术患者随机分为3组，A组（贺斯组）、B组（血定安组）和C组（晶体组）以80～100mL/3min的速度分别输入20mL/kg的6％羟乙基淀粉、4％琥珀酰明胶和乳酸林格液进行AHHD，术中以乳酸林格液补充其余液体需要量。监测AHHD前（T0）、术毕（T1）、术后24h（T2）、术后72h（T3）血尿素氮（BUN）、血肌酐（BCr），以及T0与T1时刻血β2-微球蛋白，尿β2-微球蛋白浓度和尿比重数值。结果3组各时点血尿素氮和血肌酐均在正常范围内；A组及B组尿β2-微球蛋白在T1均高于T0（P〈0．05或0．01）；组间比较，T1时刻尿β2-微球蛋白数值B组明显高于A组和C组（P〈0．01）。结论输入血定安进行AHHD能够造成。肾小管一过性的重吸收功能受损，但无围术期严重。肾损害作用。而输入中分子量的贺斯进行AHHD对于术前常规肾功能检查正常的患者肾功能无明显影响。Objective To evaluate the effects of acute-hypervolemic hemodilution （AHHD） with 6% HES （200/0.5） and 4 % gelofusine on renal function. Methods Thirty ASA Ⅰ-Ⅱ adult patients were randomly divided into 3 groups：group A was infused with 6% HES（20 mL/kg） in speed of 80-100 mL/3 min before operation followed by Ringer＇s lactate solution; group B was infused with 4 % gelofusine; group C was infused with Ringer＇ s lactate solution. The values of BCr and BUN were measured before AHHD（T0）, at the end of operation（T1）, 24 h after operation（T2）, and 72 h after operation（T3）;The values of β2-M in blood and in urine were tested before AHHD （T0）, and at the end of operation（T1）, too. Results In this research, the BUN, BCr, and volume of urine were all in the normal range and showed no difference in the intergroup comparisons and the within group comparisons. But the values after operation of β2-M in urine were much higher than the basic values in group A and group B （P〈0.05 or 0.01 ）, and there were obvious differences （P〈0.05） between the group B and the group A or group C. Conclusion AHHD with 4% gelofusine may affect the function of renal tubule. But AHHD with 6% HES （200/0.5） does not affect the renal function of normal patients.

关 键 词：胶体 急性高容量血液稀释 肾功能 

分 类 号：R619[医药卫生—外科学]