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No Differences in Renal Function between Balanced 6% Hydroxyethyl Starch (130/0.4) and 5% Albumin for Volume Replacement Therapy in Patients Undergoing Cystectomy
背景与目的
人工胶体在危重患者的使用已经减少，但在围术期治疗中还有应用。常规手术中，人工胶体对非危重患者的潜在肾毒性知之甚少。该试验的目的是评估5％白蛋白和6％（130 / 0.4）平衡羟乙基淀粉对肾功能和肾损伤的影响。
方 法
本研究为前瞻性单盲对照研究，100例择期行膀胱切除术的泌尿外科患者随机分为两组，分别接受5％白蛋白或6％（130/0.4）平衡羟乙基淀粉治疗，并作为围术期应用的唯一种类的胶体。主要指标是血清半胱氨酸蛋白酶抑制剂C在第90天的最后一次访视与术前第一次访视的比值。次要指标是术后第3天估计肾小球滤过率和血清中性粒细胞明胶酶相关载脂蛋白，以及术后第3天和第90天肾功能水平（风险、损伤、衰竭、丧失和终末期肾病）。
结 果
白蛋白组半胱氨酸蛋白酶抑制剂C比值中位数为1.11（四分位数间距：1.01-1.23），羟乙基淀粉组为1.08（四分位数间距：1.00-1.20）（中位数差0.03; 95％CI：-0.09-0.08; P = 0.165）。此外，血清半胱氨酸蛋白酶抑制剂C浓度、估计肾小球滤过率、肾功能水平（风险、损伤、衰竭、丧失和终末期肾病）以及嗜中性粒细胞明胶酶相关的脂质运载蛋白无差异。两组患者输液量、输血率和围术期血流动力学无差异。
结 论
对于肾功能和肾损伤，非危重手术患者应用5％白蛋白和6％平衡羟乙基淀粉均较安全。
原始文献摘要
Tobias Kammerer, Florian Brettner, Sebastian Hilferink,et al.No Differences in Renal Function between Balanced 6% Hydroxyethyl Starch (130/0.4) and 5% Albumin for Volume Replacement Therapy in Patients Undergoing Cystectomy[J]. Anesthesiology,2017
Background: The use of artificial colloids has declined in critical care, whereas they are still used in perioperative medicine. Little is known about the nephrotoxic potential in noncritically ill patients during routine surgery. The objective of this trial was to evaluate the influences of albumin 5% and balanced hydroxyethyl starch 6% (130/0.4) on renal function and kidney injury.
Methods: One-hundred urologic patients undergoing elective cystectomy were randomly assigned for this prospective, single-blinded, controlled study with two parallel groups to receive either albumin 5% or balanced hydroxyethyl starch 6% (130/0.4) as the only perioperative colloid. The primary endpoint was the ratio of serum cystatin C between the last visit at day 90 and the first preoperative visit. Secondary endpoints were estimated glomerular filtration rate and serum neutrophil gelatinase-associated lipocalin until the third postoperative day and risk, injury, failure, loss, and end-stage renal disease criteria at postoperative days 3 and 90.
Results: The median cystatin C ratio was 1.11 (interquartile range, 1.01 to 1.23) in the albumin and 1.08 (interquartile range, 1.00 to 1.20) in the hydroxyethyl starch group (median difference = 0.03; 95% CI, –0.09 to 0.08; P = 0.165). Also, there were no significant differences concerning serum cystatin C concentrations; estimated glomerular filtration rate; risk, injury, failure, loss, and end stage renal disease criteria; and neutrophil gelatinase-associated lipocalin. Infusion requirements, transfusion rates, and perioperative hemodynamics were similar in both groups.
Conclusions: With respect to renal function and kidney injury, this study indicates that albumin 5% and balanced hydroxyethyl starch 6% have comparable safety profiles in noncritically ill patients undergoing major surgery.
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