【罂粟摘要】肝脏及胰腺手术中比较6%羟乙基淀粉130/0.4/9和5%白蛋白安全性、容积有效性和糖萼降解影响的开放随机试验
肝脏及胰腺手术中比较6%羟乙基淀粉130/0.4/9和5%白蛋白安全性、容积有效性和糖萼降解影响的开放随机试验
贵州医科大学 高鸿教授课题组
翻译：佟睿 编辑：佟睿 审校：曹莹
本研究旨在评价羟乙基淀粉(HES)130/0.4/9与5%白蛋白在腹部大手术中对肾脏、凝血安全性、容量有效性及糖萼降解的影响。
这项研究被机构伦理委员会批准为单中心、开放性的随机试验。将50例接受肝脏或胰腺手术的患者随机分为HES组(n=25)和白蛋白组(n=25)，HES组接受HES 130/0.4/9治疗，白蛋白治疗组接受5%白蛋白治疗。输注林格氏醋酸液(3ml/kg/h)和胶体液(2ml/kg/h)进行目标液体管理以稳定血流动力学。比较两组围手术期血肌酐、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、血流动力学、凝血指标和糖萼生物标志物的变化及差异。失血量、输血量和血管活性药物需要量亦在比较范围内。统计学处理采用Mann-Whitney U检验、卡方检验或Fisher精确检验，P<0.05。
血清肌酐水平在HES组和白蛋白组之间没有差异(中位数：麻醉诱导时0.67 vs 0.75 mg/dL，ICU入院时0.82 vs 0.83 mg/dL，手术后一天0.67 vs 0.73 mg/dL，手术后一个月0.68 vs 0.70 mg/dL)。两组间NAG、凝血参数、血流动力学、糖萼生物标志物、术中失血量、输血量和血管活性药物使用情况也无差异。
HES 130/0.4/9与5%白蛋白一样安全有效。在腹部大手术中使用这些溶液，对糖萼的降解没有差别。
Open randomized trial of the effects of 6% hydroxyethyl starch 130/0.4/9 and 5% albumin on safety profile, volume efficacy, and glycocalyx degradation in hepatic and pancreatic surgery
Purpose: The aim of this study was to evaluate the effects of hydroxyethyl starch (HES) 130/0.4/9 compared to 5% albumin on renal and coagulation safety profiles, volume efficacy and glycocalyx degradation in major abdominal surgery.
Methods: The study was approved by the institutional ethics committee as a single center, open-labeled randomized trial. Fifty patients undergoing hepatic or pancreatic surgery were randomly assigned to the HES group (n = 25), who received HES 130/0.4/9, or the Albumin group (n = 25), who received 5% albumin. Ringer’s acetate solution (3 ml/kg/h) and colloid solution (2 ml/kg/h) were infused and goal-directed fluid management was performed to stabilize hemodynamics. Perioperative changes and differences in serum creatinine, N-acetyl-beta-d-glucosaminidase (NAG), hemodynamics, coagulation parameters and glycocalyx biomarkers were compared between the groups. Blood loss and requirements for transfusion and vasoactive agents were also examined. Statistical analysis was performed by Mann–Whitney U tests, chi-square or Fisher exact test, with P < 0.05 taken to be significant.
Results: Serum creatinine levels did not differ between the HES and Albumin groups (median: 0.67 vs. 0.75 mg/dL at anesthesia induction, 0.82 vs. 0.83 mg/dL at ICU admission, 0.67 vs. 0.73 mg/dL one day after surgery, 0.68 vs. 0.70 mg/dL one month after surgery). NAG, coagulation parameters, hemodynamics, glycocalyx biomarkers, intraoperative blood loss, transfusion and use of vasoactive agents did not differ between the groups.
Conclusion: HES 130/0.4/9 can be used as safely and effectively as 5% albumin. Glycocalyx degradation did not differ between use of these solutions in major abdominal surgery.
翻译：佟睿
编辑：佟睿
审校：曹莹
贵州医科大学高鸿教授课题组