European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2008
Splanchnic microcirculation protection by hydroxyethyl starches during abdominal aortic aneurysm surgery.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Mahmood A, Gosling P, Barclay R, Kilvington F, Vohra R
Аннотация
OBJECTIVE: To specifically compare the effect of two hydroxyethyl starches (HES) on the splanchnic microcirculation and systemic inflammation during abdominal aortic aneurysm (AAA) surgery.
MATERIALS AND METHODS: A prospective randomised study was carried out on 62 patients who received HES of molecular-weight 200 kDa (HES200/0.62), 130 kDa (HES130/0.4) or gelatine for 24h peri-operatively. Gastric-mucosal pHi (GpHi) and anti-endotoxin antibody were used as markers of splanchnic perfusion and endotoxaemia respectively. C-reactive protein (CRP) and lung-injury score (LIS) were used as markers of systemic inflammation and end-organ dysfunction respectively. Data was collected prospectively.
RESULTS: The drop in GpHi was least with HES200/0.62 compared to HES130/0.4 and gelatine at reperfusion (7.32 vs 7.28 and 7.28, p=0.017 and 0.009 respectively) and compared to gelatine at 2h as well (7.43 vs 7.28, p=0.001). GpHi dropped less with HES130/0.4 compared to gelatine at 2h (7.39 vs 7.28, p=0.002). Endotoxaemia increased only with gelatine. CRP was lower with HES200/0.62 (178 mg/mL) than gelatine (221 mg/mL) and HES130/0.4 (223 mg/mL) at 48 h (p=0.049 and p=0.009 respectively). There was no difference in LIS but ventilation duration was less with HES200/0.62 compared with gelatine (4 vs 11h, p=0.012).
CONCLUSION: During AAA surgery, HES200/0.62 provides the best splanchnic microcirculation protection, also reducing inflammation and duration of ventilation.
MATERIALS AND METHODS: A prospective randomised study was carried out on 62 patients who received HES of molecular-weight 200 kDa (HES200/0.62), 130 kDa (HES130/0.4) or gelatine for 24h peri-operatively. Gastric-mucosal pHi (GpHi) and anti-endotoxin antibody were used as markers of splanchnic perfusion and endotoxaemia respectively. C-reactive protein (CRP) and lung-injury score (LIS) were used as markers of systemic inflammation and end-organ dysfunction respectively. Data was collected prospectively.
RESULTS: The drop in GpHi was least with HES200/0.62 compared to HES130/0.4 and gelatine at reperfusion (7.32 vs 7.28 and 7.28, p=0.017 and 0.009 respectively) and compared to gelatine at 2h as well (7.43 vs 7.28, p=0.001). GpHi dropped less with HES130/0.4 compared to gelatine at 2h (7.39 vs 7.28, p=0.002). Endotoxaemia increased only with gelatine. CRP was lower with HES200/0.62 (178 mg/mL) than gelatine (221 mg/mL) and HES130/0.4 (223 mg/mL) at 48 h (p=0.049 and p=0.009 respectively). There was no difference in LIS but ventilation duration was less with HES200/0.62 compared with gelatine (4 vs 11h, p=0.012).
CONCLUSION: During AAA surgery, HES200/0.62 provides the best splanchnic microcirculation protection, also reducing inflammation and duration of ventilation.
Предметные рубрики MeSH
AgedAntibodiesAortic Aneurysm, AbdominalC-Reactive ProteinEndotoxinsFemaleGastric MucosaHumansHydrogen-Ion ConcentrationHydroxyethyl Starch DerivativesMaleMicrocirculationMolecular WeightPlasma SubstitutesProspective StudiesReperfusion InjuryRespiration, ArtificialSplanchnic CirculationTime FactorsTreatment Outcome