From the Department of Anaesthesiology and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia.
Shock. 2014 Mar;41(3):193-9. doi: 10.1097/SHK.0000000000000087.
NaCl 7.2%/6% hydroxyethyl starch (HES) 200/0.5 (HSH) has shown its beneficial effects in cardiac surgery and immunomodulatory values in experiment and human studies. However, there is concern regarding detrimental renal effects of chloride and HES in the intensive care setting.
The objective of this study was to evaluate the influence of HSH on kidney integrity and the level of inflammatory mediators in on-pump coronary artery bypass surgery patients.
This was a single-center, prospective, randomized, single-blind pilot study.
This work was performed at a tertiary cardiothoracic referral center during the period from February to August 2012.
Forty patients scheduled for on-pump coronary artery bypass surgery were included.
PATIENTS were randomized to receive once either 7.2% NaCl/6% HES 200/0.5 (HSH group, n = 20) or placebo (0.9% NaCl; control group, n = 20) at a dose of 4 mL·kg for 30 min after anesthesia induction.
The primary end point was the incidence of acute kidney injury (AKI) defined according to the Kidney Disease: Improving Global Outcomes. Secondary end points were peak serum cystatin C, peak urine neutrophil gelatinase-associated lipocalin, plasma levels of interleukin 6 (IL-6), IL-10, intercellular adhesion molecule 1, and endothelial-leukocyte adhesion molecule (E-selectin).
The incidence of AKI within 48 h was similar between the groups (HSH: four patients [20%]; control: six patients [30%]). There was a significantly lower peak value for serum cystatin C in the HSH group (0.83 [0.73-0.89] mg·L) compared with the control group (1.02 [0.88-1.15] mg·L; P = 0.001). PATIENTS in both groups had similar peak postoperative urine neutrophil gelatinase-associated lipocalin concentrations. NaCl 7.2%/6% hydroxyethyl starch 200/0.5 significantly reduces levels of IL-6 and IL-10 at 4 h after cardiopulmonary bypass and intercellular adhesion molecule 1 and E-selectin at 4 h after cardiopulmonary bypass and on postoperative day 1 (P < 0.05 for all).
NaCl 7.2%/6% hydroxyethyl starch 200/0.5 does not lead to the increase in AKI incidence when used for the volume therapy in on-pump coronary artery bypass surgery patients. NaCl 7.2%/6% hydroxyethyl starch 200/0.5 usage enhanced neither tubular injury nor alteration of glomerular filtration. In addition, HSH can reduce the level of the inflammatory mediators after surgery.
在心脏手术中，7.2%氯化钠/6%羟乙基淀粉（HES）200/0.5（HSH）已显示出有益的效果，在实验和人类研究中也具有免疫调节作用。然而，在重症监护环境中，人们对氯和 HES 的肾损害作用存在担忧。
本研究旨在评估 HSH 对体外循环冠状动脉旁路移植术患者肾脏完整性和炎症介质水平的影响。
这是一项单中心、前瞻性、随机、单盲的初步研究。
这项工作是在 2012 年 2 月至 8 月期间在一家三级心胸科转诊中心进行的。
纳入 40 例拟行体外循环冠状动脉旁路移植术的患者。
患者随机接受 7.2%氯化钠/6% HES 200/0.5（HSH 组，n=20）或安慰剂（0.9%氯化钠；对照组，n=20），剂量为 4 mL·kg，在麻醉诱导后 30 min 内输注。
主要终点为根据肾脏疾病：改善全球结果定义的急性肾损伤（AKI）发生率。次要终点为血清胱抑素 C 峰值、尿液中性粒细胞明胶酶相关脂质运载蛋白峰值、血浆白细胞介素 6（IL-6）、白细胞介素 10（IL-10）、细胞间黏附分子 1 和血管内皮白细胞黏附分子（E-选择素）水平。
两组患者术后 48 h 内 AKI 发生率相似（HSH 组：4 例[20%]；对照组：6 例[30%]）。HSH 组血清胱抑素 C 峰值显著低于对照组（0.83[0.73-0.89]mg·L 比 1.02[0.88-1.15]mg·L；P=0.001）。两组患者术后尿液中性粒细胞明胶酶相关脂质运载蛋白浓度相似。与对照组相比，HSH 可显著降低体外循环后 4 h 时 IL-6 和 IL-10 的水平，体外循环后 4 h 和术后第 1 天可降低细胞间黏附分子 1 和 E-选择素的水平（所有 P 值均<0.05）。
在体外循环冠状动脉旁路移植术患者中，7.2%氯化钠/6%羟乙基淀粉 200/0.5 用于容量治疗不会导致 AKI 发生率增加。HSH 既不会加重肾小管损伤，也不会改变肾小球滤过功能。此外，HSH 可降低术后炎症介质的水平。
