羟乙基淀粉130/0.4对活体肾移植患者肾功能的影响

摘要

目的 探讨活体肾移植患者围术期输注不同剂量6％羟乙基淀粉130/0.4(6％HES130/0.4)对肾功能的影响.方法 选择45例活体肾移植患者,ASAⅢ或Ⅳ级,随机均分为三组,围术期分别输注6％HES 130/0.4 15ml·kg-1·d-1(A组)、20 ml·kg-1·d 1(B组)、30ml·kg-1·d-1(C组),其中术中输入总量的2/3,术后24 h内输入1/3,余输复方乳酸钠.记录患者血流动力学变化,检测患者围术期肾功能指标.结果 三组术中SBP、DBP、HR和CVP均较平稳,组间差异无统计学意义.与术前比较,三组术后24、72 h Cr、BUN明显降低(P＜0.05或P＜0.01).与A组比较,术后24 h液体入量和术后24 h尿量C组明显减少(P＜0.05).结论 6％HES 130/0.4在15～30 ml·kg-1·d-1用于活体肾移植患者术中输液能有效维持血流动力学稳定,对围术期肾功能无明显影响.%Objective To approach the effects of hydroxyethyl starch 130/0. 4 (voluven) at different doses on renal function in patients undergoing living donor kidney trans pi antatioa Methods Forty-five ASA III or IV patients undergoing living donor kidney transplantation were randomly divided into 3 groups (n = 15 each). the dose of 6% HES 130/0. 4 was 15 ml·kg-1 ·d-1 in group A,20 ml·kg-1 ·d-1 in group B, and 30 ml o kg-1 o d-1 in group C, 2/3 of this colloid was infusioned during operation and the other 1/3 was infusioned after operatioa Before and after the opening of renal vessels 30 min. the time of the appearance of urine, blood loss, duration of surgery, the amount of fluid infused and urine output during operation, the amount of fluid infused and urine output were recorded in the postoperative 24 h. Venous blood samples were obtained before and afrer operation 24 h and 72 h for measurement of blood urea nitrogen and creatinine. Results Compared with the preoperative indexes. RP,HR,CVP were increased but not significantly different in all three groups, while the blood urea nitrogen and creatinine were decreased with significantly difference (P< 0. 05 or P<0. 01). Aflcr the opening of renal vessels, the time of urinating, blood loss, duration of surgery, the amount of fluid infused and urine output during operation of two groups were not significantly different. However, compared with group A, the amount of fluid infused and urine output in ihe postoperative 24 h of group C were significantly decreased (P<0. 05), while those in group B were stahle. Conclusion For patients undergoing living donor kidney transplantation, 6% HES 130/0. 4 could safely and effectively maintain preoperative hemodynamic stability, and had no significantly effect on the transplanted kidneys.