London M J, Franks M, Verrier E D, Merrick S H, Levin J, Mangano D T
Department of Anesthesia, University of California, San Francisco.
J Thorac Cardiovasc Surg. 1992 Aug;104(2):284-96.
Ten percent pentastarch is a low-molecular-weight hydroxyethyl starch with greater oncotic pressure and shorter intravascular persistence than 6% hetastarch. To evaluate its safety and efficacy as a component of cardiopulmonary bypass priming solution, we prospectively studied 90 patients undergoing coronary artery bypass grafting or valve replacement necessitating cardiopulmonary bypass (bubble oxygenator and moderate systemic hypothermia). Sixty patients were randomized to receive 75 gm of either 10% pentastarch (group P) or 25% albumin (group A), and 30 patients received lactated Ringer's solution alone (group C). Intravascular colloid osmotic pressure during cardiopulmonary bypass was highest with either of the colloid primes (15-minute measurement: group P, 15.7 +/- 2.2 mm Hg (mean +/- standard deviation); group A, 15.2 +/- 2.0 mm Hg; group C, 11.3 +/- 1.7 mm Hg; p less than 0.05, groups P and A compared with group C). This was associated with a lower volume requirement during cardiopulmonary bypass to maintain the venous reservoir (group P, 333 +/- 318 ml; group A, 483 +/- 472 ml; group C, 1332 +/- 1013 ml; p less than 0.05, groups P and A compared with group C). Urine output during cardiopulmonary bypass was similar in each group. Net intraoperative fluid balance was lowest in the colloid groups (groups P and A, 5.7 +/- 1.4 L; group C, 6.9 +/- 1.3 L; p less than 0.05, groups P and A compared with group C). Cardiac index shortly after weaning from cardiopulmonary bypass was greatest in group P (group P, 3.2 +/- 0.9; group A, 2.8 +/- 0.8; group C, 2.7 +/- 0.6 dyne.sec.cm-5; p less than 0.05, group P compared with group C). Changes in alveolar-arterial oxygen gradients, shunt fraction, and effective compliance were similar in all groups. During cardiopulmonary bypass, pentastarch appeared to cause the greatest degree of hemodilution, as suggested by the lowest hemoglobin, factor VII and IX levels and platelet count. The activated partial thromboplastin time was significantly prolonged during and immediately after cardiopulmonary bypass in group P relative to groups A and C (p less than 0.05), although there were no significant differences in the activated clotting time before cardiopulmonary bypass, during cardiopulmonary bypass, or after heparin neutralization. As well, clinical indices of hemostasis, including mediastinal drainage, red cell, platelet, and fresh frozen plasma requirements, and reoperation for excessive postoperative bleeding, were similar. We conclude that pentastarch, when used in cardiopulmonary bypass prime, is as safe as either albumin or Ringer's solution alone.(ABSTRACT TRUNCATED AT 400 WORDS)
10%的喷他淀粉是一种低分子量羟乙基淀粉，与6%的贺斯相比，具有更高的胶体渗透压和更短的血管内留存时间。为评估其作为体外循环预充液成分的安全性和有效性，我们前瞻性地研究了90例需要进行体外循环（鼓泡式氧合器和中度全身低温）的冠状动脉搭桥术或瓣膜置换术患者。60例患者被随机分为两组，分别接受75克10%的喷他淀粉（P组）或25%的白蛋白（A组），30例患者仅接受乳酸林格氏液（C组）。体外循环期间，两种胶体预充液组的血管内胶体渗透压最高（15分钟测量值：P组，15.7±2.2 mmHg（均值±标准差）；A组，15.2±2.0 mmHg；C组，11.3±1.7 mmHg；P组和A组与C组相比，p<0.05）。这与体外循环期间维持静脉储血器所需的较低液体量相关（P组，333±318 ml；A组，483±472 ml；C组，1332±1013 ml；P组和A组与C组相比，p<0.05）。每组体外循环期间的尿量相似。胶体组的术中净液体平衡最低（P组和A组，5.7±1.4 L；C组，6.9±1.3 L；P组和A组与C组相比，p<0.05）。体外循环撤离后不久，P组的心脏指数最大（P组，3.2±0.9；A组，2.8±0.8；C组，2.7±0.6 达因·秒·厘米⁻⁵；P组与C组相比，p<0.05）。所有组的肺泡 - 动脉氧梯度、分流分数和有效顺应性变化相似。体外循环期间，喷他淀粉似乎导致了最大程度的血液稀释，这从最低的血红蛋白、凝血因子VII和IX水平以及血小板计数可以看出。与A组和C组相比，P组在体外循环期间及之后活化部分凝血活酶时间显著延长（p<0.05），尽管在体外循环前、体外循环期间或肝素中和后活化凝血时间没有显著差异。同样，包括纵隔引流、红细胞、血小板和新鲜冰冻血浆需求量以及因术后出血过多而再次手术等止血的临床指标相似。我们得出结论，喷他淀粉用于体外循环预充时，与单独使用白蛋白或林格氏液一样安全。（摘要截短至400字）
