不同剂量6%羟乙基淀粉130/0.4用于老年髋关节置换术中的安全性分析  

Efficacy and safety of 6% hydroxyethyl starch 130/0.4 with different doses in elderly patients undergoing hip arthroplasty under combined spinal epidural anesthesia

作　　者：江秀清 余功敏 吴青华 王巍 占霖森 JIANG Xiuqing;YU Gongmin;WU Qinghua;WANG Wei;ZHAN Linsen(Department of Anesthesiology,Affiliated Quzhou Hospital of Wenzhou Medical University,Quzhou People's Hospital,Quzhou 324000,China)

机构地区：[1]温州医科大学附属衢州医院(衢州市人民医院)麻醉科,324000 [2]温州医科大学附属衢州医院(衢州市人民医院)骨科,324000

出　　处：《浙江医学》2021年第7期735-739,共5页Zhejiang Medical Journal

摘　　要：目的分析不同剂量6%羟乙基淀粉(HES)130/0.4用于腰硬联合麻醉下老年髋关节置换术的安全性。方法选择2016年5月至2017年12月温州医科大学附属衢州医院择期行髋关节置换术的69例老年患者为研究对象,术前肾功能检查正常,按照随机数字表法分为6%HES 130/0.47.5 ml/kg(A组)、6%HES 130/0.415 ml/kg(B组)和乳酸林格液对照组(LR组),每组23例。监测3组患者术前(T0)、开始切皮前(T1)、切皮后5min(T2)、髋关节置换后即刻(T3)、术毕(T4)时的血流动力学指标,以及术前、术中、术后尿量、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、IL-18、尿β2-微球蛋白(β2-MG)、尿微量白蛋白(mALB)和血肌酐(Scr)、血NGAL、血IL-18等水平的变化并作比较。结果A、B组MAP在T2、T3时间点较LR组显著升高(均P<0.05)。3组患者术前、术中、术后尿量、尿NGAL、尿β2-MG、尿mALB、Scr、血IL-18和血NGAL水平差异均无统计学意义(均P>0.05);3组患者术后尿IL-18水平均急剧升高(均P<0.05),但3组间差异无统计学意义(P>0.05)。A、B组血管活性药物使用率、围术期恶心、呕吐发生率较LR组低(均P<0.05)。结论老年髋关节置换术患者在围术期输注7.5、15 mg/kg的6%HES 130/0.4均不会发生急性肾损伤,还能降低术中低血压、血管活性药物使用率及围术期恶心、呕吐的发生率。Objective To analyze the safety and efficacy of different doses of 6%hydro xyethyl starch(HES)130/0.4 in elderly patients undergoing hip replacement under combined spinal epidural anesthesia.Methods Sixty nine elderly patients with normal renal func tion who underwent elective hip replacement in Quzhou Hospital of Wenzhou Medical University from May 2016 to December 2017 were enrolled in the study.Patients were randomly divided into three groups with 23 cases in each group.Groups A and B were injected with 6%HES 130/0.47.5 ml/kg and 15 ml/kg before anesthesia,respectively,while LR group was injected with 15 ml/kg lactate Ringer’s solution.Infusion speed and vasoactive drugs were adjusted according to changes in blood pressure and heart rate during surgery to maintain stable circulation.The urinary NGAL,IL-18,β2-microglobin(β2-MG),mALB and serum creatinine(Scr),blood NGAL and blood IL-18 concentrations before,during and after operation were monitored.Results The mean artery pressure(MAP)in group A and B was significantly higher than LR group at time points F2 and T3(P<0.05),there were no significant differences in urine volume,urinary NGAL,β2-MG,mALB,and Scr,blood IL-18,NGAL among the three groups before,during and after surgery(P>0.05).Postoperative urinary IL-18 of the three groups was significantly increased(P<0.05),but the difference among the three groups was not statistically significant(P>0.05).The utilization rate of vasoactive drugs and the incidence of perioperative nausea and vomiting in group A and B were lower than those in LR group(P<0.05).Conclusion Perioperative infusion of 6%HES 130/0.4(7.5 mg/kg,15 mg/kg)in elderly patients with hip arthroplasty may not cause acute kidney injury,but can reduce the use of vasoactive drugs and the incidence of intraoperative hypotension,and perioperative nausea and vomiting.

关 键 词：急性肾损伤 老年患者 羟乙基淀粉 白介素18 中性粒细胞明胶酶相关脂质运载蛋白 

分 类 号：R614[医药卫生—麻醉学]