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アプロチニン,失血,そして腎機能不全は,深度の低温循環停止で起こります
C T Mora Mangano1, M J Neville, P H Hsu
1Department of Anesthesia and Cardiothoracic Surgery, Stanford University, Stanford, California, USA. cmoraman@stanford.edu
Circulation
|September 25, 2001
まとめ
アプロチニンは,深度の低体温循環停止 (DHCA) 患者の腎機能障害リスクを増加させないが,失血を減少させない. 輸血や尿出荷などの要因は,DHCA手術で腎臓の問題を予測します.
科学分野:
- 心胸外科手術についてです.
- 心血管外科手術についてです.
- ネフロロジーは腎臓科
- アネステシオロジー アネステシオロジー
背景:
- 心胸外科手術における深度の低温循環停止 (DHCA) は,失血および腎機能不全のリスクを高めます.
- セリンプロテアゼ阻害剤であるアプロチニンは,失血を軽減するために使用されますが,腎臓の懸念のためにDHCAでの安全性については議論されています.
研究 の 目的:
- DHCAによる心血管外科手術を受ける患者の輸血需要と腎機能に対するアプロチニンの効果を評価する.
主な方法:
- 853人の大動脈または胸腔腹腔外科手術を受けた患者を遡及的にレビューし,DHCAで治療された203人の患者に焦点を当てました.
- 腎機能不全を25%の減少として定義するために,手術前および手術後のクレアチニンクリアランス (CRCl) の分析.
- アプロチニンの使用を含む腎機能不全に関連する要因を特定するための多変数回帰.
主要な成果:
- DHCAは手術後のCRCl (86〜67mL/分) を著しく減少させた.
- 患者の38%が手術後の腎機能不全を経験した.
- アプロチニンの使用は,腎機能不全の増加 (P=0.951) と関連せず,輸血の必要性を有意に減少させなかった.
- 腎機能不全に関連した要因には,より高い赤血球の需要,尿量の減少,ドーパミンの不使用,低血圧が含まれています.
結論:
- DHCA患者にアプロチニンを投与すると,腎機能不全のリスクは上昇しません.
- アプロチニンは,DHCAにおける外科手術後の失血を効果的に軽減しない可能性があります.
- 尿産量の減少と輸血の必要性の増加は,DHCAにおける手術後の腎機能不全の主要な予測因子です.
- ドーパミンは,DHCA中に腎臓の保護を提供することができます.
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