新型羟乙基淀粉HES 130/0.4与HES 200/0.5在急性等容性血液稀释期间及之后的血浆置换效果比较

Plasma substitution effects of a new hydroxyethyl starch HES 130/0.4 compared with HES 200/0.5 during and after extended acute normovolaemic haemodilution.

作者信息

Ickx B E, Bepperling F, Melot C, Schulman C, Van der Linden P J

机构信息

Department of Anaesthesiology, Erasme University Hospital, 808 route de Lennik, B-1070 Brussels, Belgium.

出版信息

Br J Anaesth. 2003 Aug;91(2):196-202. doi: 10.1093/bja/aeg159.

DOI:10.1093/bja/aeg159

PMID:12878617

Abstract

BACKGROUND

The volume expansion effect of a recently introduced hydroxyethyl starch, HES 130/0.4, was compared with the commonly used HES 200/0.5 after rapid infusion of a single large dose (up to 2 litres) administered during acute normovolaemic haemodilution (ANH).

METHODS

This prospective, randomized, double-blind study included 40 patients scheduled for major abdominal surgery with no contraindication to ANH. Patients were randomized to undergo ANH with either HES 130/0.4 (n=20) or HES 200/0.5 (n=20). Blood was collected to reach a target haemoglobin level of about 8.0 g dl(-1) and simultaneously replaced by the same volume of colloid (HES 130: 1825 [SD 245] ml; HES 200: 1925 [183] ml). Heart rate, mean arterial pressure, cardiac filling pressure, and cardiac output were measured before induction of anaesthesia (baseline), 10 min after completion of ANH, before surgery, at the end of surgery and on the following morning (postoperative day 1; POD1). ANH blood was systematically retransfused during surgery or before POD1.

RESULTS

Exchange of about 40% of blood volume resulted in similar haemodynamic changes in both groups. Filling pressures increased significantly, while cardiac index remained unchanged (HES 130: from 3.3 [0.4] to 3.2 [0.7] litre min(-1) m(-2); HES 200: from 3.0 [0.6] to 3.1 [0.7] litre min(-1) m(-2)). Need for crystalloids and colloids was similar between the groups during surgery and on POD1. Total blood loss (HES 130: median 2165 ml, range 660-2970 ml; HES 200: median 2464 ml, range 640-19 380 ml) and amount of allogeneic red blood cells transfused (HES 130: median 0, range 0-4 units; HES 200: median 0, range 0-18 units) were comparable in the two groups.

CONCLUSIONS

This study demonstrates a good immediate and medium-term plasma volume substitution effect of HES 130 compared with HES 200. HES 130 could represent a suitable synthetic colloid for plasma volume substitution during extensive ANH.

摘要

背景

在急性等容性血液稀释（ANH）期间快速输注单次大剂量（最多2升）后，将一种新引入的羟乙基淀粉HES 130/0.4的扩容效果与常用的HES 200/0.5进行比较。

方法

这项前瞻性、随机、双盲研究纳入了40例计划进行腹部大手术且无ANH禁忌证的患者。患者被随机分为接受HES 130/0.4（n = 20）或HES 200/0.5（n = 20）进行ANH。采集血液以使血红蛋白水平达到约8.0 g dl⁻¹的目标水平，同时用相同体积的胶体液替代（HES 130：1825 [标准差245] ml；HES 200：1925 [183] ml）。在麻醉诱导前（基线）、ANH完成后10分钟、手术前、手术结束时及次日早晨（术后第1天；POD1）测量心率、平均动脉压、心脏充盈压和心输出量。在手术期间或POD1之前系统地回输ANH血液。

结果

两组中约40%血容量的置换导致了相似的血流动力学变化。充盈压显著升高，而心脏指数保持不变（HES 130：从3.3 [0.4] 升至3.2 [0.7] 升·分钟⁻¹·米⁻²；HES 200：从3.0 [0.6] 升至3.1 [0.7] 升·分钟⁻¹·米⁻²）。手术期间及POD1时，两组对晶体液和胶体液的需求相似。两组的总失血量（HES 130：中位数2165 ml，范围660 - 2970 ml；HES 200：中位数24,64 ml，范围640 - 19,380 ml）和输注的异体红细胞量（HES 130：中位数0，范围0 - 4单位；HES 200：中位数0，范围0 - 18单位）相当。