RETRACTED ARTICLE: Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: comparison of a new starch preparation with gelatin
RETRACTED ARTICLE: Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: comparison of a new starch preparation with gelatin
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撤回文章：两种不同容量替代方案对接受心脏手术的老年患者肾功能的影响：新型淀粉制剂与明胶的比较
作者：
J. Boldt;T. Brenner;A. Lehmann;J. Lang;B. Kumle;C. Werling
羟乙基淀粉（HES）对肾功能的影响一直受到关注。设计前瞻性随机研究。设置大学附属医学中心。患者40例年龄>70岁的连续患者接受体外循环心脏手术。干预措施低分子羟乙基淀粉（HES）（平均分子量：130 kD），具有低取代度（0.4）在麻醉诱导后给予6%羟乙基淀粉130/0.4（n=20）或明胶（n=20），直至术后第2天（POD），以将中心静脉压保持在12- 15之间。测定肌酐清除率（CC）和钠清除率（FSC）。从尿液标本中测定N-乙酰-β-D-氨基葡萄糖苷酶、α-1-微球蛋白、谷胱甘肽转移酶-pi和谷胱甘肽转移酶-α。在麻醉诱导后、手术结束时以及第一次和第二次POD时进行测量。研究中输注的明胶（总量：4150±490 ml）多于HES 130/0.4（总量：3450±450 ml）。CC和FSC在两组间无差异。所有测量的肾脏特异性蛋白在基线时几乎在正常范围内。然而，手术后它们显著增加，没有显著的组间差异。在第2 POD，肾脏特异性蛋白质几乎恢复到正常值。没有患者发生急性肾功能衰竭。结论肾功能不全的敏感标志物增加，在我们的老年患者中，表明在心脏手术过程中肾脏的完整性中度改变。在接受心脏手术的老年患者中，两种容量替代方案在肾脏完整性方面没有差异。
ObjectiveThere is continuing concern on the influence of hydroxethyl starch (HES) on renal function.DesignProspective, randomized study.SettingUniversity-affiliated medical center.PatientsForty consecutive patients aged >70 years undergoing cardiac surgery using cardiopulmonary bypass.InterventionsEither low-molecular HES (mean molecular weight: 130 kD) with low degree of substitution (0.4) (6% HES 130/0.4) (n=20) or gelatin (n=20) was given after induction of anesthesia until the 2nd postoperative day (POD) to keep central venous pressure between 12–14 mmHg.Measurements and resultsCreatinine clearance (CC) and fractional sodium clearance (FSC) were measured. N-acetyl-beta-D-glucosamidase , alpha-1-microglobulin , glutathione transferase-pi , and glutathione transferase-alpha were measured from urine specimens. Measurements were made after induction of anesthesia, at the end of surgery, and at the first and the second POD. More gelatin (total: 4150±490 ml) than HES 130/0.4 (total: 3450±450 ml) was infused within the study. CC and FSC were without differences between the two groups. All measured kidney-specific proteins were almost within normal range at baseline. They increased significantly after surgery, however, without significant group differences. At the 2nd POD, kidney-specific proteins had returned almost to normal values. None of the patients developed acute renal failure.ConclusionsSensitive markers of kidney dysfunction increased in our elderly patients indicating moderate alterations in kidney integrity during cardiac surgery. The two volume replacement regimens did not differ with regard to kidney integrity in elderly patients undergoing cardiac surgery.