Mastroianni L, Low H B, Rollman J, Wagle M, Bleske B, Chow M S
Department of Anesthesia, Hartford Hospital, CT 06115.
J Clin Pharmacol. 1994 Jan;34(1):34-40. doi: 10.1002/j.1552-4604.1994.tb03963.x.
Colloids are useful in cardiac surgery to increase preload and improve cardiac output without the risks associated with blood transfusions. Pentastarch is a new low-molecular weight hydroxyethyl starch compound under investigation for this purpose. The authors compared, in a randomized fashion, 12 patients who received pentastarch and 17 patients who received albumin for volume expansion after open-heart surgery. During the 24-hour study period there was no significant difference between the two groups with respect to systemic blood pressure, mean arterial pressure, cardiac index, right atrial pressure, and pulmonary capillary wedge pressure, with the exception of a higher mean arterial pressure and systolic blood pressure at 4 hours in the albumin group and higher heart rate at 12 hours in the pentastarch group. In addition, postoperative prothrombin time, partial thromboplastin time, fibrinogen, platelets, and factor VIII levels were not significantly different between the two groups. There were no complications attributed to colloid administration. The hemodynamic parameters were further evaluated in a subset of 6 pentastarch and 9 albumin patients who received the first 500 mL of colloid in a similar time frame and under similar clinical conditions. The patients who received pentastarch showed a significantly greater increase in cardiac index than did the patients who received albumin. No significant change in other parameters were noted between the two groups. The authors conclude that pentastarch is as safe as albumin and may be a more effective volume expander than albumin when used in open-heart surgery patients.
胶体在心脏手术中有助于增加前负荷并改善心输出量，且无输血相关风险。喷他淀粉是一种新型低分子量羟乙基淀粉化合物，正为此目的进行研究。作者以随机方式比较了12例接受喷他淀粉的患者和17例接受白蛋白用于心脏直视手术后扩容的患者。在24小时研究期间，两组在全身血压、平均动脉压、心脏指数、右心房压和肺毛细血管楔压方面无显著差异，但白蛋白组在4小时时平均动脉压和收缩压较高，喷他淀粉组在12小时时心率较高。此外，两组术后凝血酶原时间、部分凝血活酶时间、纤维蛋白原、血小板和因子VIII水平无显著差异。未出现归因于胶体给药的并发症。在6例接受喷他淀粉和9例接受白蛋白的患者亚组中，在相似时间框架和相似临床条件下给予首剂500 mL胶体后，对血流动力学参数进行了进一步评估。接受喷他淀粉的患者心脏指数的增加显著大于接受白蛋白的患者。两组间其他参数未发现显著变化。作者得出结论，喷他淀粉与白蛋白一样安全，在心脏直视手术患者中使用时可能是比白蛋白更有效的扩容剂。
