羟乙基淀粉130/0.4对老年患者肾功能的影响

目的观察老年患者输注羟乙基淀粉130/0.4(HES130/0.4)对肾小球和肾小管功能的影响。方法全麻老年患者50例均分为HES130/0.4组(H组)和生理盐水(NS)组(N组)。麻醉诱导后以10ml.kg-1.h-1速率从颈内静脉分别输注HES130/0.4(H组)和NS(N组)。监测输注前(T0)、诱导后(T1)、HES130/0.4或NS输注完毕时(T2)、术后24h(T3)、48h(T4)的SBP和DBP。在T0、T3、T4时用放免法测尿β2微球蛋白(β2-MG)、尿晶体渗透压,血、尿同步检测尿素氮(BUN)和肌酐(Cr),计算肾小球滤过率(GFR);于T0～T4时用酶联免疫吸附法(ELISA)测定视黄醇结合蛋白(RBP)、N-乙酰-β-葡萄糖苷酶(NAG)、免疫球蛋白(IgG)、白蛋白(Alb)。结果两组患者输注前后SBP和DBP无明显变化。与T0时比较,两组T1～T4时尿RBP、NAG、IgG、Alb均明显升高(P0.05或P0.01)。两组输注前后尿β2-MG、尿晶体渗透压、GFR均无明显变化。结论输注HES130/0.425ml/kg对老年患者肾功能无明显影响。

Effects of hydroxyethyl starch 130/0. 4 on renal function in the elderly

Objective To assess the effects of hydroxyethyl starch130/0. 4 (HES130/0. 4) on glomerular and tubular functions in the elderly. Methods Fifty elder patients, undergoing general anesthesia were randomly assigned to two groups of H and N, with 25 cases each. After intubation, HES 130/0. 4 25 ml/kg was infused in a dose of 10 ml·kg~(-1)·h~(-1) in group H and 0. 9% Nacl was used instead of HES in group N. SBP and DBP were monitored before operation(T_0) ,after intubation(T_1),at the end o[infusion of HES 130/0. 4 or NS(T_2), at 24 h(T_3) and 48 h(T_4) postoperatively. At T_0, T_3 and T_4, concentrations of β_2-microglobulin (β_2-MG) urine crystalloid osmotic pressure, urea nitrogen(BUN) and creafinine (Cr) in blood and urine were measured. Retinol-binding protein(RBP), N-acetyl-β-glucosa-minidase(NAG), immunoglobulin G(IgC;) and albumin(Alb) were measured at all 5 time points. Glomerular filtration rate(GFR) was calculated. Results SBP and DBP had no significant differences among all time points between two groups. Compared to at T_0 ,RBP, NAG, IgG and Alb were all significantly increased at T_1-T_4 in both groups(P<0.01 or P<0. 05). There were no significant differences in β_2-MG, crystalloid osmotic pressure and GFR among different time points or between two groups. Conclusion Intraoperative infusion of HES 130/0. 4 at a dose of 25 ml/kg does not have any significant effects on the renal function in the elderly.