补充10%及20%浓度人血白蛋白对心肺转流术后患者肾功能的影响

Effects of 10% and 20% human serum albumin on renal functions of patients after cardiopulmonary bypass

摘要:

目的 探讨10%及20%的人血白蛋白(HSA)对心肺转流(CPB)心脏手术患者术后肾功能的影响。方法 选取徐州医科大学附属医院重症医学科2016年3月至2016年12月接受CPB心脏手术后低蛋白血症患者100例,按随机数字表法将患者分为接受10% HSA组及20% HSA组,每组各50例。2组患者给予对应浓度HSA,至白蛋白(ALB)水平＞35 g/L。记录并比较2组患者术后临床相关指标、肾功能、HSA使用量、药物使用情况、尿量及ICU停留时间、术后住院时间等差异。应用SPSS 21.0软件进行统计分析。根据数据类型,组间比较采用非配对t检验或χ²检验,组内比较采用单因素方差分析。结果 2组患者术后当天ALB均较术前明显下降,补充HSA后第1、2天ALB水平有所上升但仍低于术前水平(P<0.05)；术后当天2组患者血肌酐(SCr)水平升高不明显,但术后第1、2天较术前明显升高(P<0.05)；2组患者尿素氮(BUN)水平在手术当天、第1、2天呈上升趋势,但第1、2天水平显著高于手术前(P<0.05)；手术当天2组患者血红蛋白(Hb)显著低于手术前,术后第1、2天有不同程度升高,但仍低于术前水平(P<0.05)；术前及术后2组患者各时间点ALB、SCr、BUN、尿酸(UA)、Hb比较,差异均无统计学意义(P>0.05)。与10%HSA组比较,20%HSA组HSA用量降低[(21.20±8.81) vs(30.00±10.41)g, P<0.01],术后第2天尿量明显增多,差异有统计学意义[(2.62±0.67) vs (2.13±0.82)ml/(kg·h),P<0.05]。其他相关指标在2组间差异均无统计学意义(P>0.05)。结论 10%及20%浓度的HSA对CPB心脏手术后低蛋白血症患者肾功能无明显不同影响,但20%的HSA使用总量少,且在增加术后尿量方面效果较好。

Abstract:

Objective To explore the different effects of 10% and 20% human serum albumin (HSA)solutions on the renal functions of the patients after cardiopulmonary bypass (CPB). Methods Totally 100 patients with hypoalbuminemia were enrolled in this study who received CPB from March 2016 to December 2016 in our department. The patients were randomly divided into 2 groups (20%HSA and 10%HSA, n=50). HAS were administered in all patients until the albumin (ALB) concentration was>35 g/L. The two groups were compared postoperatively in the aspects of relevant clinical indicators, the renal functions, the amount of HAS administered, drug usage, urine output, length of stay in the ICU, and postoperative hospital stay. SPSS statistics 21.0 was used for statistical analysis. Non-paired t test and Chi-square test was adopted for comparison between groups according to the data types, and univariate analysis of variance was used for intragroup comparison. Results ALB in the 2 groups decreased significantly on the day of operation compared with before operation, and in the first and second day after CPB, the level of ALB had some increases, but still lower than that before operation (P<0.05). The increase of serum creatinine (SCr) level in 2 groups was not obvious immediately after the operation compared with before operation, but in the first and second day, SCr were significantly higher (P<0.05). Blood urea nitrogen (BUN) in the 2 groups showed an upward trend in the day of operation, the first and second day after the operation, and BUN in the first and second day were significantly higher than that before operation(P<0.05); hemoglobin (Hb) level in the 2 groups in the day of operation were obviously lower than that before operation, and there were some different increases in the first and second day after operation, but still lower than that before operation(P<0.05). There was no significant difference at the same time point between the 2 groups before and after the operation, such as ALB, SCr, BUN, uric acid (UA) and Hb (P>0.05). A smaller amount of HSA were administered in the patients in 20%HSA group than those in 10%HSA group [(21.20±8.81) vs (30.00±10.41)g, P<0.01]. Besides, compared with 10%HSA group, the postoperative urine output on the second day was higher in 20%HSA group [(2.62±0.67) vs (2.13±0.82)ml/(kg·h), P<0.05]. No significant differences were found in other relevant indices between groups (P>0.05). Conclusion There is no significant difference between two HSA solutions(10% and 20%)in their effects on the renal function in the patients with hypoalbuminemia who had undergone CPB. However, administration of 20%HSA can significantly reduce the amount of albumin used to treat hypoproteinemia. In terms of increased postoperative urine output, 20%HSA is superior to 10%HSA.