琥珀酰明胶和羟乙基淀粉130/0.4在老年重症冠状动脉旁路移植患者中的应用比较  

Comparison of effects of gelatin and hydroxyethyl starch 130/0.4 in elderly severe patients undergoing coronary artery bypass surgery

作　　者：饶竹青[1] 陈宇[1] 丁正年[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2015年第9期1247-1251,共5页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的 :研究老年重症冠状动脉旁路移植术(coronary artery bypass surgery,CABG)患者术中应用琥珀酰明胶(Gelatin)和低分子量羟乙基淀粉(HES130/0.4),对扩容效果、不良反应及临床预后的影响。方法:选择40例60岁以上的老年重症CABG患者,随机分成两组,分别以Gelatin或HES130/0.4行术中容量替代治疗,观察记录Gelatin组和HES组晶体及胶体使用量、凝血功能、出血量和血制品的输注量、血清肌酐变化以及气管插管拔管时间、ICU住院时间和术后住院时间等指标,并进行对比统计分析。结果:术中晶体用量无明显差异,胶体用量Gelatin组较HES组稍低,但差异无统计学意义(P=0.35);两组凝血功能、出血量及血制品的输注量差异均无统计学意义;两组在术后第1天均出现了一过性的血清肌酐升高(P≤0.01),但均至术后第4、7天恢复正常,组间差异无统计学意义;两组气管插管拔管时间及ICU住院时间无明显差异,Gelatin组较HES组术后住院时间延长,但差异无统计学意义。结论:对于60岁以上老年CABG重症病例,术中应用Gelatin或HES130/0.4,两组扩容效果以及常见不良反应如肾功能、凝血功能损伤等均无明显差异。Objective：To compare intraoperative use of gelatin and hydroxyethyl starch 130 / 0.4 in elderly severe patients undergoing coronary artery bypass surgery, in terms of volume expansion efficiency, side effects and clinical prognosis. Methods：Forty severe patients aged ≥60 years old undergoing coronary artery bypass surgery were randomized to receive intraoperative gelatin（n =20） or HES130 / 0.4（n =20） as volume replacement. Amount of crystalloid and colloid solution, blood coagulation, bleeding,blood products infusion, serum creatinine, and time for tracheal tube extraction, length of stay in ICU and hospital were measured and compared. Results： Intraoperative amount of gelatin was slightly less than HES130 / 0.4（P =0.35）, while amount of crystalloid solution needed between groups was comparable. No significant difference of blood coagulation, bleeding and blood products infusion was found between groups. Serum creatinine increased transiently in both groups to a comparable extent on the 1stPOD, and subsequently decreased to normal on the 4thand 7thPOD, with no difference between groups at each time point. Time for tracheal tube extraction and length of stay in ICU did not differ significantly between groups, while hospital length of post-operative stay was longer but not significantly in Gelatin group compared to HES130 / 0.4 group. Conclusion： In elderly severe patients undergoing coronary artery bypass surgery, intraoperative volume therapy with gelatin or HES130 / 0.4 showed no significant difference between groups in terms of both volume expansion efficiency and side effects like blood coagulation and renal function.

关 键 词：琥珀酰明胶 羟乙基淀粉130/0.4 冠状动脉旁路移植 扩容效果 凝血功能 肾功能 

分 类 号：R654.2[医药卫生—外科学]