Division of Gastrointestinal Surgery, E Floor, West Block, Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Br J Anaesth. 2012 Aug;109(2):168-76. doi: 10.1093/bja/aes098. Epub 2012 Apr 16.
This study aims to study changes in blood volume after 1 litre infusions of Gelofusine(®) [4% succinylated gelatine in 0.7% saline, weight-average molecular weight (MWw) 30 kDa] and Voluven(®) (6% hydroxyethyl starch in 0.9% saline, MWw 130 kDa) in the presence of increased capillary permeability.
In this randomized double-blind study, adults undergoing laparoscopic cholecystectomy received 1 litre of Gelofusine(®) (n=12) or Voluven(®) (n=13) over 1 h at the induction of anaesthesia. No other fluids were given. Haematocrit, serum electrolytes, and osmolality were measured before infusion and hourly thereafter for 4 h. Changes in blood volume were calculated from changes in haematocrit. The urinary albumin:creatinine ratio (ACR) was measured before and after operation.
Baseline parameters before the two infusions were similar (P>0.050). The urinary ACR increased significantly after operation after Gelofusine(®) (P=0.011) and Voluven(®) (P=0.002), indicating increased capillary permeability. Voluven(®) produced a greater increase in serum chloride concentration (P=0.028) and a larger decrease in strong ion difference (P=0.009) than Gelofusine(®). There were no significant differences in changes in haematocrit (P=0.523) and blood volume (P=0.404) over the study period when the two infusions were compared, nor were there any differences in serum sodium, potassium, bicarbonate, and albumin concentrations (P>0.050). Urine output, sodium concentration, and osmolality were similar after the two infusions (P>0.050).
The blood volume-expanding effects of the two colloids were not significantly different, despite the increase in postoperative urinary ACR and the 100 kDa difference in MWw.
本研究旨在研究在增加毛细血管通透性的情况下，1 升 Gelofusine(®)[4%琥珀酰化明胶在 0.7%盐水中，重均分子量（MWw）为 30 kDa]和 Voluven(®)[6%羟乙基淀粉在 0.9%盐水中，MWw 为 130 kDa]输注后血容量的变化。
在这项随机、双盲研究中，接受腹腔镜胆囊切除术的成年人在麻醉诱导时接受 1 升 Gelofusine(®)(n=12)或 Voluven(®)(n=13)，输注时间为 1 小时。在此期间未给予其他液体。在输注前和输注后每小时测量血细胞比容、血清电解质和渗透压。从血细胞比容的变化中计算出血容量的变化。在手术前后测量尿白蛋白/肌酐比值（ACR）。
两种输注前的基线参数相似（P>0.050）。输注后 Gelofusine(®)（P=0.011）和 Voluven(®)（P=0.002）后，尿 ACR 显著增加，表明毛细血管通透性增加。与 Gelofusine(®)相比，Voluven(®)使血清氯浓度升高（P=0.028），使强离子差降低（P=0.009）。两种输注在研究期间的血细胞比容变化（P=0.523）和血容量变化（P=0.404）无显著差异，血清钠、钾、碳酸氢盐和白蛋白浓度也无差异（P>0.050）。两种输注后尿量、钠浓度和渗透压相似（P>0.050）。
尽管术后尿 ACR 增加且 MWw 相差 100 kDa，但两种胶体的扩容效果并无显著差异。
