目的 比较围术期输注琥珀酰明胶与羟乙基淀粉(130/0.4)对老年病人肾功能的影响.方法 择期乳腺手术、甲状腺手术病人40例,随机分为两组,即琥珀酰明胶组(G组)和羟乙基淀粉组(V组);G组自切皮开始输入20 ml/kg的琥珀酰明胶,V组则输入20 ml/kg的羟乙基淀粉,以醋酸林格氏液补充其余体液体需要量,术后第1天和第2天,继续分别输入20ml/kg·天的琥珀酰明胶和羟乙基淀粉.记录麻醉前(T0)、术毕(T1)、术毕5小时(T2)、术后第1天(T3)、第2天(T4)以及第3天(T5)各时点的心率、平均动脉压、CVP值,测定以上各点血肌酐(Cr),血、尿α1微球蛋白(α1-M)、视黄醇结合蛋白(RBP)浓度.结果 两组患者生命体征、血Cr浓度在各个时点差异均无显著性(P＞0.05);两组患者血α1-M浓度在各个时点差异亦无显著性(P＞0.05),但较正常值(10～30mg/L)有升高;尿α1-M、尿RBP浓度在手术开始后进行性升高,T2～T5与T0比较,差异有显著性(P＜0.05);而在T2～T5的4个时点上,V组较G组升高的幅度更大,差异有显著性(P＜0.05).结论 通过对肾功能敏感指标的监测表明,羟乙基淀粉相对于琥珀酰明胶,其对肾功能影响更大,而且主要是影响了肾小管的功能.%Objective To compare the influence of succinylated gelatin and hydroxyethyl starch(130/0.4) on renal function in the elderly during perioperative period. Methods Forty patients undering breast operation and thyroid operation were randomly equally divided into G group and V group. 20starch; and supplemented the rest essential liquid with acetated Ringer's solution. On the first and second postoperative day, the same Gelofusine was infused in G group, and the V group with the same hydroxyethyl starch. HR, MAP, CVP, serum creatinine(Cr), hematological α 1-microglobulin, urinary α1-microglobulin and retinol-binding protein(RBP) were measured before anesthesia(T0), at the end of operation(T1), 5 hours after operation(T2), on the first(T3), second(T4) and third(Ts) postoperative day. Results Vital sign and Cr were normal in both groups. The level of hematological α1-microglobulin was higher than normal, but had no significant difference between G group and V group. The level of urinary α1-microglobulin and retinolbinding protein(RBP) in both groups increased significantly at T2 ～ T5 as compared with T1; and the level of these two parameters in V group were significantly higher than G group at T2 ～ T5. Conclusion This study show that, compare with succinylated gelatin, hydroxyethyl starch has more influence on renal function, especially on renal tubule, in the elderly.
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