羟乙基淀粉130/0.4对活体肾移植患者肾功能的影响  

Perioperative effect of different doses of hydroxyethyl starch 130/0.4 on renal function in patients undergoing living donor kidney transplantation

作　　者：疏树华[1] 柴小青[1] 李传耀[1] 章蔚[1] 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2012年第8期742-744,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨活体肾移植患者围术期输注不同剂量6%羟乙基淀粉130/0.4(6%HES130/0.4)对肾功能的影响。方法选择45例活体肾移植患者,ASAⅢ或Ⅳ级,随机均分为三组,围术期分别输注6%HES130/0.415ml·kg-1·d-1(A组)、20ml·kg-1·d-1(B组)、30ml·kg-1·d-1(C组),其中术中输入总量的2/3,术后24h内输入1/3,余输复方乳酸钠。记录患者血流动力学变化,检测患者围术期肾功能指标。结果三组术中SBP、DBP、HR和CVP均较平稳,组间差异无统计学意义。与术前比较,三组术后24、72hCr、BUN明显降低(P<0.05或P<0.01)。与A组比较,术后24h液体入量和术后24h尿量C组明显减少(P<0.05)。结论 6%HES130/0.4在15～30ml·kg-1·d-1用于活体肾移植患者术中输液能有效维持血流动力学稳定,对围术期肾功能无明显影响。Objective To approach the effects of hydroxyethyl starch 130/0. 4 （voluven） at different doses on renal function in patients undergoing living donor kidney transplantation. Methods Forty five ASA Ⅲ or Ⅳ patients undergoing living donor kidney transplantation were randomly divided into 3 groups （n=15 each） . the dose of 6% HES 130/0. 4 was 15 ml.kg^- 1 .d ^-1 in groupA.20ml.kg^- 1 .d ^-1 in group B. and 30ml.kg^- 1 .d ^-1 in group C, 2/3 of this colloid was infusioned during operation and the other 1/3 was infusioned after operatioru Before and after the opening of renal vessels 30 min, the time of the appearance of urine, blood loss, duration of surgery, the amount of fluid infused and urine output during operation, the amount of fluid infused and urine output were recorded in the postoperative 24 h. Venous blood samples were obtained before and after operation 24 h and 72 h for measurement of blood urea nitrogen and ereatinine. Results Compared with the preoperative indexes, BP, HR,CVP were increased but not significantly different in all three groups, while the blood urea nitrogen and creatinine were decreased with significantly difference （P〈 0. 05 or p〈0.01）. After the opening of renal vessels, the time of urinating, blood loss, duration of surgery, the amount of fluid infused and urine output during operation of two groups were not significantly different. However, compared with group A, the amount of fluid infused and urine output in the postoperative 24 h of group C were significantly decreased（P〈 0. 05）, while those in group B were stable. Conclusion For patients undergoing living donor kidney transplantation, 6% HES 130/0.4 could safely and effectively maintain preoperalive hemodynamie stability, and had no significandy effect on the transplanted kidneys.

关 键 词：羟乙基淀粉130/0.4 肾移植 肾功能 围手术期 

分 类 号：R614[医药卫生—麻醉学]