摘要
目的:研究国产胶体液应用于急性等容量血液稀释(ANH)对肾脏功能的影响。方法:选择128例可能需输血的手术患者,随机均分成4组:(1)对照组(D组)不进行血液稀释;(2)乳酸林格液组(L组);(3)羟乙基淀粉(200/0.5)氯化钠注射液组(Q组);(4)琥珀酰明胶注射液(H组),实施ANH。设计理想血细胞压积(HCT)为30%,经桡动脉放血,术中据具体情况予以输入自体放出血或异体血等,围术期持续监测生命体征,记录出血量、输血量,监测放血前后血红蛋白、HCT、血小板计数、凝血功能、活化凝血时间(ACT)值等,术前、术后1d、7d查肾功能、血β2-微球蛋白,收集尿液监测尿量、肾小球滤过率,尿β2-微球蛋白及检查尿沉淀,记录监测数据进行统计学分析。结果:D组均输异体血红细胞悬液2～3U、血浆400mL,Q组、H组放血前后平均动脉压(MAP)、中心静脉压(CVP)及心率(HR)无明显变化,L组放血后5min、15min和30minMAP、CVP较放血前明显下降,HR则明显上升,均具有显著差异(P<0.05);3组实施ANH患者放血前、后凝血功能均在正常范围,术后未见明显凝血功能障碍;术后1d各组有患者血尿素氮和肌酐血Β2-微球蛋白较术前升高,但总体上无显著性差异(P>0.05)。结论:羟乙基淀粉氯化钠注射液和琥珀酰明胶注射液作为扩容剂应用于ANH对肾脏功能影响小,可明显减少术中输异体血,临床应用安全。
Objective：To investigate the changes of renal function induced by acute normovolemic hemodilution with domestic plasma substitutes. Methods：There were 120 patients scheduled for elective surgery in this study,all were randomly divided into four groups. The control group （Group D）,Lactate Ringer＇s injection group （Group L）,Hydroxyethyk starch and sodium chloride injection （Group Q）and gelofusine injection group （Group H）. The desired end-point HCT was 30%. After induction,blood was withdrawn from radial artery and collected in standard blood bags. Vital signs were monitored and the amount of blood loss and transfusion were recorded.Hemoglobin,hematocrit platelet count,blood coagulation and the standard activated clotting time （ACT） was checked before and after blood hemodilution,BUN,Cr,blood and urea β2-microglobulins,Amount of urine,glomerular filtration rate and urea precipitation were checked before operation and 1 day and 7days after operation. Results：The amount of blood transfusion of foreign body was 2-3U packed red blood cells（PRBCs） and 400ml fresh-frozen plasma（FFP） in group D. The MAP and CVP decreased and HR increased significantly 5 min,15 min and 30 min in Group L after blood withdrawn（P0.05）,there was no significant change in MAP,CVP and HR in Group Q and Group H before and after blood withdraw,the same was in blood coagulation in Group Q and Group H. The levels of blood BUN,Cr and β2-microglobulins were increased in each group 1 day after operation but there was no significance among the four groups（P0.05）. Conclusions：Acute normovolemic hemodilution with domestic hdroxyethyk starch and gelofusine injection has little effect on renal function and can significantly decrease the demand of blood products.
出处
《中国临床医学》
2010年第2期251-253,共3页
Chinese Journal of Clinical Medicine
关键词
胶体液
急性等容量血液稀释
肾脏功能
Plasma substitutes
Acute normovolemic hemodilution
Renal function
