The effects of hydroxyethyl starch compared with gelofusine on activated endothelium and the systemic inflammatory response following aortic aneurysm repair.
OBJECTIVE
To investigate the effect of HES, used as a plasma volume expander, on endothelial cell activation induced by ischaemia-reperfusion in humans.


METHODS
Forty patients undergoing elective infrarenal aneurysm repair were randomised to receive either gelatine or hydroxyethyl starch solution as plasma expanders. The anaesthetic technique was standardised. All patients received the same crystalloid as per standard protocol. Urine samples and blood samples were collected at various times for assessment of microalbuminuria and von Willebrand factor (vWf) and CRP.


RESULTS
The peak C-reactive protein was significantly lower in the patients treated with HES than those treated with gelofusine [142 mg/L (113,196 mg/L) vs 246 mg/L (189,291 mg/L) mg/L, P < 0.01, Mann-Whitney test]. The peak ACR was also significantly lower in the HES treated patients (9.3 mg/mmol vs 23.3 mg/mmol, P < 0.05). The plasma level of vWf was significantly higher in the gelofusine treated patients than those treated with HES [173.5 U/dl Vs 80.5 U/dl, P < 0.001, at 4 hr; 160 U/dl Vs 82.5 U/dl, P < 0.001, at 8 hr; 191 U/dl Vs 100.5 U/dl, P < 0.001, at 12 hr; 209 U/dl Vs 81.0 U/dl, P < 0.001, at 24 hr].


CONCLUSIONS
HES may damp down the systemic inflammatory response and reduce endothelial cell dysfunction.
Rittoo
D
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Department of Vascular Surgery, Selly Oak Hospital, Selly Oak, Birmingham B29 6JD, UK. drms@btinternet.com
Gosling
P
P
Simms
M H
MH
Smith
S R G
SR
Vohra
R K
RK
D000368:Aged; D000419:Albuminuria; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis*; D002199:Capillary Permeability; D003102:Colloids; D004730:Endothelium, Vascular / Q000378:metabolism*; D005121:Extremities / Q000098:blood supply; D005260:Female; D005780:Gelatin / Q000494:pharmacology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D008297:Male; D010952:Plasma Substitutes / Q000494:pharmacology*; D010976:Platelet Count; D015427:Reperfusion Injury / Q000517:prevention & control; D013386:Succinates / Q000494:pharmacology*; D014841:von Willebrand Factor / Q000032:analysis
D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D013386:Succinates; D014841:von Willebrand Factor; C060085:succinylated gelatin; D005780:Gelatin; D002097:C-Reactive Protein