Skytte Larsson J, Bragadottir G, Krumbholz V, Redfors B, Sellgren J, Ricksten S E
Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
Br J Anaesth. 2015 Nov;115(5):736-42. doi: 10.1093/bja/aev346.
In the present randomized study, we evaluated the differential effects of a colloid and a crystalloid fluid on renal oxygen delivery (RD(O2)), glomerular filtration (GFR), renal oxygen consumption ((RV(O2))), and the renal oxygen supply-demand relationship (i.e., renal oxygenation) after cardiac surgery with cardiopulmonary bypass.
Thirty patients with normal preoperative renal function, undergoing uncomplicated cardiac surgery, were studied in the intensive care unit in the early postoperative period. Patients were randomized to receive a bolus dose of either a crystalloid (Ringers-acetate 20 ml kg(-1), n=15) or a colloid solution (Venofundin) 10 ml kg(-1), n=15). Systemic haemodynamics were measured via a pulmonary artery catheter. Renal blood flow and GFR were measured by the renal vein retrograde thermodilution technique and by renal extraction of 51Cr-EDTA (=filtration fraction). Arterial and renal vein blood samples were obtained for measurements of renal oxygen delivery (RD(O2)) and RV(O2). Renal oxygenation was estimated from the renal oxygen extraction.
Despite an increase in cardiac index and renal blood flow with both fluids, neither of the fluids improved RD(O2), because they both induced haemodilution. The GFR increased in the crystalloid (28%) but not in the colloid group. The crystalloid increased the filtration fraction (24%) and renal oxygen extraction (23%), indicating that the increase in GFR, the major determinant of RV(O2), was not matched by a proportional increase in RD(O2).
Neither the colloid nor the crystalloid improved RD(O2) when used for postoperative plasma volume expansion. The crystalloid-induced increase in GFR was associated with impaired renal oxygenation, which was not seen with the colloid.
NCT01729364.
在本随机研究中，我们评估了胶体液和晶体液对体外循环心脏手术后肾氧输送（RD（O2））、肾小球滤过率（GFR）、肾氧消耗（（RV（O2）））以及肾氧供需关系（即肾氧合）的不同影响。
30例术前肾功能正常、接受无并发症心脏手术的患者在术后早期入住重症监护病房进行研究。患者被随机分为两组，分别接受大剂量的晶体液（复方醋酸林格液20 ml/kg，n = 15）或胶体液（万汶）10 ml/kg，n = 15）。通过肺动脉导管测量全身血流动力学。采用肾静脉逆行热稀释技术和51Cr - EDTA肾摄取法（=滤过分数）测量肾血流量和GFR。采集动脉和肾静脉血样以测量肾氧输送（RD（O2））和RV（O2）。根据肾氧摄取估算肾氧合。
尽管两种液体均使心脏指数和肾血流量增加，但两种液体均未改善RD（O2），因为它们均引起血液稀释。晶体液组GFR增加（28%），而胶体液组未增加。晶体液使滤过分数（24%）和肾氧摄取（23%）增加，这表明作为RV（O2）主要决定因素的GFR增加并未伴有RD（O2）的相应增加。
用于术后扩容时，胶体液和晶体液均未改善RD（O2）。晶体液引起的GFR增加与肾氧合受损有关，而胶体液未出现这种情况。
NCT01729364。
