羟乙基淀粉130/0.4对合并急性肾功能不全地震伤患者肾功能的影响

摘要

Objective To retrospectively analyze the use of hydroxyethyl starch(HES)130/0.4 in injured patients with acute renal failure(ARF)in Wenchuan earthquake,and its influence on the renal function.Methods Critically ill traumatic patients with ARF admitted to intensive care unit(ICU)of West China Hospital within 1 month after Wenchuan earthquake were divided into two groups according to whether or not HES 130/0.4 was used(Y group for having used it and N group for not).The basic clinical data and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were obtained on admission.Serum blood urea nitrogen(BUN)and creatinine(SCr)on day 1,3,7,14 and 28 were compared between two groups,as well as the time of continous renal replacement therapy(CRRT)and mechanical ventilation (MV),transfusion amount,and 28-day motality rate.The usage of HES 130/0.4 was recorded in Y group,including total days.maximum daily amount.total amount and average amount being used.Results A total of 39 patients were enrolled into the study,30 in Y group,9 in N group.No statistical difference was found in basic clinical data and APACHEⅡscore on admission to ICU.Also there was no difference in days of CRRT and MV,or transfusion amount.Serum BUN and SCr on day 1,3,7,1 4 and 28 after admission to ICU showed no significant difference between two groups,except for SCr concentration on day 1(P＜0.05).In Y group,the mean duration of using HES 130/0.4 was 3 days,mean daily amount was (529.9±226.3)ml,maximum daily amount was 2 500 ml,minimum daily amount was 500 ml(none exceeded recommended dosage).total amount used was 500-13500 ml.The 28-day motality rate in Y group was 26.7%,no patient died in N group within 28 days.Conclusion No negative influence on the renal function imparted bv HES 130/0.4 is found in critically m traumatic patients with ARF.%目的 回顾性分析"5·12"四川汶川特大地震后合并急性.肾功能不全的创伤患者使用羟乙基淀粉(HES)130/0.4的情况,及其对患者肾功能的影响.方法 收集2008年5月12日-6月12日本科住院治疗时存在急性肾功能不全的地震创伤患者,以是否使用HES 130/0.4分为使用组(Y组)和未使用组(N组),统计并比较患者入科时基本情况、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,1个月内Y组患者使用HES 130/0.4时间、每日最大剂量、总使用剂量以及平均剂量;比较两组患者入科1、3、7、14及28 d血清尿素氮(BUN)与肌酐(SCr)水平、28 d内连续性肾脏替代治疗(CRRT)持续时间、呼吸机带机时间、输血总量以及28 d病死率.结果 共39例患者纳人研究,其中Y组30例,N组9例.两组患者人科时基本情况与APACHEⅡ评分差异无统计学意义.Y组患者平均使用HES 130/0.4时间为3 d,每日剂量为(529.9±226.3)ml,每日最大剂量为2 500 ml,最小剂量为500 ml,总使用量为500～13 500 ml.除1 d时Y组SCr显著低于N组(P＜0.05)外,入科1、3、7、14及28 d两组血清BUN与SCr水平及28 d内CRRT持续时间、呼吸机带机时间、输血总量比较差异均无统计学意义.Y组28 d病死率为26.7%,N组为0.结论 HES130/0.4并不造成合并急性肾功能不全的创伤患者肾功能损害加重.