Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
J Cardiothorac Vasc Anesth. 2010 Jun;24(3):399-407. doi: 10.1053/j.jvca.2010.03.001.
Balanced fluids appear to be have advantages over unbalanced fluids for correcting hypovolemia. The effects of a new balanced hydroxyethyl starch (HES) were studied in cardiac surgery patients.
Prospective, randomized, unblinded study.
Clinical study in a single cardiac surgery institution.
Sixty patients undergoing elective cardiac surgery with cardiopulmonary bypass.
Patients received either a balanced 6% HES 130/0.4 plus a balanced crystalloid (n = 30) or an unbalanced HES-in-saline plus saline (n = 30) to keep cardiac index >2.5 L/min/m(2).
Base excess (BE), kidney function, inflammatory response (interleukins-6, -10), endothelial activation (intercellular adhesion molecule-1 [ICAM]), and coagulation (thromboelastometry, whole blood aggregation) were measured after induction of anesthesia, after surgery and 5 hours later, and at the 1st and 2nd postoperative days; 2,950 +/- 530 mL of balanced and 3,050 +/- 560 mL of unbalanced HES were given. BE was reduced significantly in the unbalanced group (from 1.11 +/- 0.71 mmol/L to -5.11 +/- 0.48 mmol/L after surgery) and remained unchanged in the balanced group. Balanced volume replacement resulted in significantly lower IL-6, IL-10, and ICAM plasma concentrations and lower urine concentrations of kidney-specific proteins than in the unbalanced group. After surgery, thromboelastometry data and platelet function were changed significantly in both groups; 5 hours thereafter they were significantly changed only in the unbalanced group.
A plasma-adapted HES preparation in addition to a balanced crystalloid resulted in significantly less decline in BE, less increase in concentrations of kidney-specific proteins, less inflammatory response and endothelial damage, and fewer changes in hemostasis compared with an unbalanced fluid strategy.
平衡液在纠正低血容量方面似乎优于非平衡液。本研究旨在观察一种新型平衡羟乙基淀粉（HES）在心脏手术患者中的作用。
前瞻性、随机、非盲研究。
单中心心脏手术机构的临床研究。
60 例行体外循环心脏手术的择期患者。
患者接受平衡的 6%HES130/0.4 加平衡晶体液（n = 30）或非平衡 HES 加生理盐水（n = 30）治疗，以维持心指数＞2.5 L/min/m2。
麻醉诱导后、手术后及 5 小时后、术后第 1 天和第 2 天分别测量基础碱剩余（BE）、肾功能、炎症反应（白细胞介素-6、白细胞介素-10）、内皮激活（细胞间黏附分子-1[ICAM]）和凝血（血栓弹性图、全血聚集）。给予平衡液 2950 ± 530 mL 和非平衡液 3050 ± 560 mL。非平衡组 BE 明显降低（术后从 1.11 ± 0.71 mmol/L 降至-5.11 ± 0.48 mmol/L），而平衡组 BE 无变化。平衡容量替代治疗使非平衡组 IL-6、IL-10 和 ICAM 血浆浓度及肾脏特异性蛋白尿浓度显著降低。手术后，两组血栓弹性图数据和血小板功能均明显改变；5 小时后，仅非平衡组有显著变化。
与非平衡液策略相比，添加平衡晶体液的血浆适应型 HES 制剂可显著减少 BE 下降、肾脏特异性蛋白浓度升高、炎症反应和内皮损伤，以及止血功能变化。
