心脏直视手术中不同血浆代用品对肝肾功能的影响.DOCVIP

临床医学论文-心脏直视手术中不同血浆代用品对肝肾功能的影响 【摘要】? 目的 比较新一代中分子羟乙基淀粉（万汶）与琥珀酰明胶（血定安）用于体外循环（extracorporeal circulation,ECC）心脏手术对肝肾功能的影响，探讨两者在心血管手术中容量治疗的有效性和安全性。方法 选择50例行瓣膜置换术的患者，随机分为两组:分别为万汶组（W组，n＝25）和血定安组（X组，n＝25）。W组在ECC前、ECC中及ICU的整个围手术期间应用万汶作为ECC预充液和补充血容量的血浆代用品；X组为对照组，围术期应用血定安作为ECC预充和补充血容量的血浆代用品。观察两组患者临床恢复情况及围术期血浆胶体渗透压（COP）、肝肾功能等各项指标的变化 。结果 两组患者均痊愈出院，各项指标比较差别均无显著性意义（P0.05）。结论 万汶、血定安均可安全用于心脏直视手术围术期的容量治疗。 【关键词】? 心脏手术 体外循环 血浆代用品 羟乙基淀粉 琥珀酰明胶 ??? Abstract: OBJECTIVE?? To compare the clinical effect to liver and renal function of using 6% hydroxyethyl starch 130/0.4 and 4% succinylated gelatin in heart surgery,and to investigate the efficacy and safety of these two artificial colloids fluids .?METHODS?50 patients programmed?for the?elective valve replacement were randomized to receive 6% hydroxyethyl starch 130/0.4?(group W,n=25) and 4% succinylated gelatin?(group X,n=25). The two fluids were used in priming heart-lung machine and intra-and postoperative plasma volume substitution. Colloid osmotic pressure(COP),levels of liver and renal function were measured perioperatively. RESULTS?All the patients were recovery and discharged . There were no significant differences in the parameters between two groups. CONCLUSION?There are no difference in the effect to liver and renal function between 6% hydroxyethyl starch 130/0.4 and 4% succinylated gelatin, they are all safe and effective in heart surgery. ??? Key words：? Cardiac surgery;Extracorporeal circulation;Volume replacement;Hydroxyethyl?? starch;Gelatin;Function ??? 为避免传播血液感染性疾病，目前体外循环(extracorporeal circulation,ECC)下心脏直视手术围术期血容量补充和预充一般均选用人工胶体，如羟乙基淀粉及琥珀酰明胶等血浆代用品。早期羟乙基淀粉类制剂分子量大，会导致肾小管堵塞，大量应用对肾功能有一定损伤。羟乙基淀粉130/0.4（万汶）是新一代产品，已被大量应用于临床，但其对肝肾功能影响的报道较少。我们以血定安为对照，观察两者在心脏外科手术中对肝肾功能的影响。 ???? 1? 资料与方法 ??? 1.1? 临床资料? 50例风湿性瓣膜病择期行瓣膜置换手术的患者随机分为两组：万汶组（W组）与血安定组（X组），每组25例。两组分别于ECC前静脉滴注、ECC中预充6%羟乙基淀粉130/0.4注射液(万汶)和4%琥珀酰明胶注射液（血定安）。两组患者一般临床资料见表1。 ??? 1.2? 麻醉及ECC方法? 两组患者均采用气管插管,静吸复合麻醉。使用Stockert或Jostra型人工心肺机,Medtronic 膜式氧合器; 常规建立ECC。ECC 中的流量维持在2. 4～