羟乙基淀粉对肾移植受体肾功能影响 .pptx

羟乙基淀粉对肾移植受体肾功能影响 渗透性肾病 因静脉滴注高渗溶液引起肾小管细胞肿胀、 空泡样变性称为渗透性肾病 osmotic-nephrosis,临床可表现为蛋白尿、血尿、肾功能损害,严重者发生急性肾衰竭、 一般认为大剂量高渗液引起肾小管上皮细胞肿胀,空泡样变致肾小管闭塞引起渗透性肾病,估计与肾小管-肾小球反馈机理以及高浓度高渗液引起肾血管痉挛有关。 Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients M L Cittanova, I Leblanc, Ch Legendre, C Mouquet, B Riou, P Coriat THE LANCET ,Vol 348 • December 14, 1996 Background Hydroxyethylstarch used as a plasma-volume expander in brain-dead kidney donors has been suggested to induce osmotic-nephrosis-like lesions、 Methods 52 patients who had received hydroxyethylstarch or iodinated contrast-media before brain death were excluded、 69 other brain-dead patients were prospectively included over 18 months and randomised into two groups、 Among these 69, multiple organs were obtained in 29, including kidneys in 27 cases、 Multiple organ procurement was not possible in 40 patients because of relatives’ refusal (25), cardiac arrest (7), cancer (1), sepsis (2), viral hepatitis or HIV infection (3), and coroner’s refusal (2)、、 We therefore studied 27 organ donors(hydroxyethylstarch-gelatin 15,gelatin-only 12) 、 In the hydroxyethylstarch-gelatin group, patients received hydroxyethylstarch up to 33 mL/kg for colloid plasma-volume expansion, and afterwards received modified fluid gelatin、 In the gelatin-only group, patients received only modified fluid gelatin as colloid plasma-volume expander、 All organ donors received fluid expansion according to transoesophageal echographic data、 Hypovolaemia was diagnosed when left-ventricular end-diastolic area (LVEDa) was below 5·5 cm 2 /m 2 、 Catecholamine doses were adjusted to obtain a mean arterial pressure between 60 and 100 mm Hg, after fluid loading if necessary、 Findings There were no significant differences in the characteristics of patients between the two groups of kidney donors or of recipients (except for a small imbalan