Effects of acute plasma volume expansion on renal perfusion, filtration, and oxygenation after cardiac surgery: a randomized study on crystalloid vs colloid
Effects of acute plasma volume expansion on renal perfusion, filtration, and oxygenation after cardiac surgery: a randomized study on crystalloid vs colloid
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DOI：
10.1093/bja/aev346
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发表时间：
2015-11-01
影响因子：
9.8
通讯作者：
Ricksten, S. -E.
中科院分区：
文献类型：
--
作者：
Larsson, J. Skytte;Bragadottir, G.;Ricksten, S. -E.
背景资料：在本随机研究中，我们评估了胶体和晶体液对肾氧输送（RDO 2）、肾小球滤过（GFR）、肾氧消耗（RVO 2）和肾氧供需关系的不同影响（即肾氧合）。方法：30例术前肾功能正常的患者接受了简单的心脏手术，在术后早期在重症监护室进行了研究。患者随机接受晶体（Ringers-acetate（R）20 ml/kg，n=15）或胶体溶液（Venofundin（R）10 ml/kg，n=15）的推注剂量。通过肺动脉导管测量全身血流动力学。肾血流量和GFR通过肾静脉逆行热稀释技术和Cr-51-EDTA（=滤过分数）的肾提取来测量。采集动脉和肾静脉血样，用于测量肾氧输送（RDO 2）和RVO 2。肾氧合估计从肾oxygen extraction.Results：尽管心脏指数和肾血流量与两种液体的增加，无论是液体改善RDO 2，因为他们都诱导血液稀释。晶体组GFR增加（28%），但胶体组没有增加。晶体增加了滤过分数（24%）和肾氧摄取（23%），表明GFR的增加（RVO 2的主要决定因素）与RDO 2的增加不成比例。结论：胶体和晶体用于术后血浆扩容时均未改善RDO 2。晶体诱导的GFR增加与肾氧合受损相关，而胶体未观察到。临床试验注册：NCT 01729364。
Background: In the present randomized study, we evaluated the differential effects of a colloid and a crystalloid fluid on renal oxygen delivery (RDO2), glomerular filtration (GFR), renal oxygen consumption (RVO2), and the renal oxygen supply-demand relationship (i.e. renal oxygenation) after cardiac surgery with cardiopulmonary bypass.Methods: 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 (R) 20 ml kg(-1), n=15) or a colloid solution (Venofundin (R) 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 Cr-51-EDTA (=filtration fraction). Arterial and renal vein blood samples were obtained for measurements of renal oxygen delivery (RDO2) and RVO2. Renal oxygenation was estimated from the renal oxygen extraction.Results: Despite an increase in cardiac index and renal blood flow with both fluids, neither of the fluids improved RDO2, 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 RVO2, was not matched by a proportional increase in RDO2.Conclusions: Neither the colloid nor the crystalloid improved RDO2 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. Clinical trial registration: NCT01729364.