羟乙基淀粉对肾移植受体肾功能影响演示文稿

羟乙基淀粉对肾移植受体肾功能影响演示文稿现在是1页\一共有30页\编辑于星期三（优选）羟乙基淀粉对肾移植受体肾功能影响现在是2页\一共有30页\编辑于星期三渗透性肾病因静脉滴注高渗溶液引起肾小管细胞肿胀、空泡样变性称为渗透性肾病

osmotic-nephrosis，临床可表现为蛋白尿、血尿、肾功能损害，严重者发生急性肾衰竭.现在是3页\一共有30页\编辑于星期三现在是4页\一共有30页\编辑于星期三一般认为大剂量高渗液引起肾小管上皮细胞肿胀，空泡样变致肾小管闭塞引起渗透性肾病，可能与肾小管-肾小球反馈机理以及高浓度高渗液引起肾血管痉挛有关。现在是5页\一共有30页\编辑于星期三Effectofhydroxyethylstarchinbrain-deadkidneydonorsonrenalfunctioninkidney-transplantrecipientsMLCittanova,ILeblanc,ChLegendre,CMouquet,BRiou,PCoriat

THELANCET

，Vol348•December14,1996现在是6页\一共有30页\编辑于星期三BackgroundHydroxyethylstarchusedasaplasma-volumeexpanderinbrain-deadkidneydonorshasbeensuggestedtoinduceosmotic-nephrosis-likelesions.现在是7页\一共有30页\编辑于星期三Methods52patientswhohadreceivedhydroxyethylstarchoriodinatedcontrast-mediabeforebraindeathwereexcluded.现在是8页\一共有30页\编辑于星期三69otherbrain-deadpatientswereprospectivelyincludedover18monthsandrandomisedintotwogroups.现在是9页\一共有30页\编辑于星期三Amongthese69,multipleorganswereobtainedin29,includingkidneysin27cases.Multipleorganprocurementwasnotpossiblein40patientsbecauseofrelatives’refusal(25),cardiacarrest(7),cancer(1),sepsis(2),viralhepatitisorHIVinfection(3),andcoroner’srefusal(2)..现在是10页\一共有30页\编辑于星期三Wethereforestudied27organdonors(hydroxyethylstarch-gelatin15,gelatin-only12).现在是11页\一共有30页\编辑于星期三Inthehydroxyethylstarch-gelatingroup,patientsreceivedhydroxyethylstarchupto33mL/kgforcolloidplasma-volumeexpansion,andafterwardsreceivedmodifiedfluidgelatin.现在是12页\一共有30页\编辑于星期三Inthegelatin-onlygroup,patientsreceivedonlymodifiedfluidgelatinascolloidplasma-volumeexpander.现在是13页\一共有30页\编辑于星期三Allorgandonorsreceivedfluidexpansionaccordingtotransoesophagealechographicdata.Hypovolaemiawasdiagnosedwhenleft-ventricularend-diastolicarea(LVEDa)wasbelow5·5cm2/m2.现在是14页\一共有30页\编辑于星期三

Catecholaminedoseswereadjustedtoobtainameanarterialpressurebetween60and100mmHg,afterfluidloadingifnecessary.现在是15页\一共有30页\编辑于星期三FindingsTherewerenosignificantdifferencesinthecharacteristicsofpatientsbetweenthetwogroupsofkidneydonorsorofrecipients(exceptforasmallimbalanceinsexintherecipients).现在是16页\一共有30页\编辑于星期三现在是17页\一共有30页\编辑于星期三现在是18页\一共有30页\编辑于星期三

Noadversereactiontoeitherexpanderwasobserved.Also,therewasnosignificantdifferenceinserumcreatininelevelbeforeorganprocurement(mean[SD])84[38]µmol/Linthehydroxyethylstarchgroupversus89[29]µmol/Linthegelatin-onlygroup.现在是19页\一共有30页\编辑于星期三Duringthefirst8daysaftertransplantation,nineof27(33%)patientsrequiredextrarenalhaemodialysisinthehydroxyethylstarch-gelatingroupcomparedwithoneof20(5%)inthegelatin-onlygroup(p=0·029).现在是20页\一共有30页\编辑于星期三Serumcreatinineconcentrationsweresignificantlylowerinthegelatin-onlygroupthanintheothergroup(p=0·009).10daysaftertransplantation,mean(SD)serumcreatininewas,respectively,145(70)and312(259)µmol/L.现在是21页\一共有30页\编辑于星期三现在是22页\一共有30页\编辑于星期三

Ninerenal-biopsyspecimenswereexamined(sixinthegelatin-onlygroup).Allthreespecimensinthehydroxyethylstarch-gelatingrouphadosmotic-nephrosis-likelesionsinthetubules.现在是23页\一共有30页\编辑于星期三现在是24页\一共有30页\编辑于星期三Inthisprospectiverandomisedstudywefoundthatadministrationofhydroxyethylstarchtobrain-deadkidneydonorsworsenedtheprognosisofrenaltransplantation.现在是25页\一共有30页\编辑于星期三Wesawahigherfrequencyofextrarenalhaemodialysisduringthefirst8days,andincreasedserumcreatinineduringthefirst10days.现在是26页\一共有30页\编辑于星期三

Therenalbiopsiesinninekidneyrecipientsshowedosmotic-nephrosis-likelesionsonlyinthehydroxyethylstarch-gelatingroup.现在是27页\一共有30页\编辑于星期三Mostlyproximalbutalsodistaltubuleswereaffected.Theselesionswerefoundinkidney-transplantbiopsyspecimensaslongas2yearsaftertransplantation(datafromChL),whichsuggestsathesaurisomamechanism.现在是28页\一共有30页\编辑于星期三InterpretationThesedatasuggestthathydroxyethylstarchu