羥乙基淀粉對腎移植受體腎功能影響演示文稿

羥乙基淀粉對腎移植受體腎功能影響演示文稿現(xiàn)在是1頁\一共有30頁\編輯于星期三（優(yōu)選）羥乙基淀粉對腎移植受體腎功能影響現(xiàn)在是2頁\一共有30頁\編輯于星期三滲透性腎病因靜脈滴注高滲溶液引起腎小管細胞腫脹、空泡樣變性稱為滲透性腎病

osmotic-nephrosis，臨床可表現(xiàn)為蛋白尿、血尿、腎功能損害，嚴重者發(fā)生急性腎衰竭.現(xiàn)在是3頁\一共有30頁\編輯于星期三現(xiàn)在是4頁\一共有30頁\編輯于星期三一般認為大劑量高滲液引起腎小管上皮細胞腫脹，空泡樣變致腎小管閉塞引起滲透性腎病，可能與腎小管-腎小球反饋機理以及高濃度高滲液引起腎血管痙攣有關。現(xiàn)在是5頁\一共有30頁\編輯于星期三Effectofhydroxyethylstarchinbrain-deadkidneydonorsonrenalfunctioninkidney-transplantrecipientsMLCittanova,ILeblanc,ChLegendre,CMouquet,BRiou,PCoriat

THELANCET

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

Catecholaminedoseswereadjustedtoobtainameanarterialpressurebetween60and100mmHg,afterfluidloadingifnecessary.現(xiàn)在是15頁\一共有30頁\編輯于星期三FindingsTherewerenosignificantdifferencesinthecharacteristicsofpatientsbetweenthetwogroupsofkidneydonorsorofrecipients(exceptforasmallimbalanceinsexintherecipients).現(xiàn)在是16頁\一共有30頁\編輯于星期三現(xiàn)在是17頁\一共有30頁\編輯于星期三現(xiàn)在是18頁\一共有30頁\編輯于星期三

Noadversereactiontoeitherexpanderwasobserved.Also,therewasnosignificantdifferenceinserumcreatininelevelbeforeorganprocurement(mean[SD])84[38]μmol/Linthehydroxyethylstarchgroupversus89[29]μmol/Linthegelatin-onlygroup.現(xiàn)在是19頁\一共有30頁\編輯于星期三Duringthefirst8daysaftertransplantation,nineof27(33%)patientsrequiredextrarenalhaemodialysisinthehydroxyethylstarch-gelatingroupcomparedwithoneof20(5%)inthegelatin-onlygroup(p=0·029).現(xiàn)在是20頁\一共有30頁\編輯于星期三Serumcreatinineconcentrationsweresignificantlylowerinthegelatin-onlygroupthanintheothergroup(p=0·009).10daysaftertransplantation,mean(SD)serumcreatininewas,respectively,145(70)and312(259)μmol/L.現(xiàn)在是21頁\一共有30頁\編輯于星期三現(xiàn)在是22頁\一共有30頁\編輯于星期三

Ninerenal-biopsyspecimenswereexamined(sixinthegelatin-onlygroup).Allthreespecimensinthehydroxyethylstarch-gelatingrouphadosmotic-nephrosis-likelesionsinthetubules.現(xiàn)在是23頁\一共有30頁\編輯于星期三現(xiàn)在是24頁\一共有30頁\編輯于星期三Inthisprospectiverandomisedstudywefoundthatadministrationofhydroxyethylstarchtobrain-deadkidneydonorsworsenedtheprognosisofrenaltransplantation.現(xiàn)在是25頁\一共有30頁\編輯于星期三Wesawahigherfrequencyofextrarenalhaemodialysisduringthefirst8days,andincreasedserumcreatinineduringthefirst10days.現(xiàn)在是26頁\一共有30頁\編輯于星期三

Therenalbiopsiesinninekidneyrecipientsshowedosmotic-nephrosis-likelesionsonlyinthehydroxyethylstarch-gelatingroup.現(xiàn)在是27頁\一共有30頁\編輯于星期三Mostlyproximalbutalsodistaltubuleswereaffected.Theselesionswerefoundinkidney-transplantbiopsyspecimensaslongas2yearsaftertransplantation(datafromChL),whichsuggestsathesaurisomamechanism.現(xiàn)在是28頁\一共有30頁\編輯于星期三InterpretationThesedatasuggestthathydroxyethylstarchu