Role of Different Replacement Fluids During Extracorporeal Treatment in a Pig Model of Sepsis

In an extracorporeal combination therapy, the impact of different replacement fluids on survival was tested in a bacterial sepsis model in pigs. In an animal study 19 pigs, weighing 7.5–11.1 kg, were included. All groups received an intravenous lethal dose of live Staphylococcus aureus over 1 h. The animals were treated by an extracorporeal circuit consisting of online centrifugation and subsequent plasma filtration for 4 h. The extracorporeal circuit was pre‐filled with 400 mL replacement fluid. In the P0 group 100% hydroxyethyl starch 130/0.4 was used as replacement fluid; in the P30 group 30% pig plasma and 70% hydroxyethyl starch; and in the P100 group 100% pig plasma. The observation time was 7 days. All animals of the group P100 survived, while all animals of group P0 and five out of seven animals of the P30 group died during the observation time. Extracorporeal therapy consisting of online centrifugation and plasma filtration with 100% pig plasma as replacement fluid significantly improved survival in a pig model of sepsis. Further studies with this approach are encouraged.     

围手术期的液体治疗进展

液体治疗是围手术期的重要治疗手段.选择正确的输液和合理的治疗策略可以著降低围手术期并发症,缩短患者住院天数,改善预后.围手术期液体治疗的历史发展是一个对“选择晶体或胶体”、“选择开放或限制补液”等有争议问题不断总结、探索、论证的前进过程.在这个过程中,广大医师对具体的围手术期治疗策略有了更深层次的认识,出现了诸如目标导向性液体治疗,早期目标导向治疗、快速通道外科等临床上有显著疗效的具体治疗策略.本文对围手术期液体治疗的进展进行综述.     

庆大霉素聚氰基丙烯酸正丁酯毫微球在小鼠体内的分布

目的：了解庆大霉素毫微球的体内分布特征及主要影响因素。方法：采用同位素标记和液闪计数方法研究GM-NP在小鼠体内的分布。结果：GM与NP结合后，体内分布发生很大变化，肝、脾、肺中摄取增加，肌肉和血中分布下降；与溶液组相比，NP给药后放射性在体内下降更缓慢；亲水性表面活性剂可使网状内皮系统的分布减少。首次证实药物浓度也影响NP的体内分布。结论：本研究加深了对GM－NP体内行为的认识。     

Scintigraphic method to quantify the passage from brain parenchyma to the deep cervical lymph nodes in rats

In order to investigate the kinetics of the passage from the brain parenchyma to the lymphatic system in vivo a high resolution scintillation camera technique was developed. Albumin, albumin colloids and dextran labelled with ^99mTc were injected into the right side of the thalamus of anesthetized rats. Continuous measurement of the activity distribution in head and neck were performed for 70 min. Rate constants were calculated by means of a computer program for compartment analysis. The animals were killed 10 h postinjection, to measure the activity in tissue samples. For some animals, images were registered up to 24 h after injection. This work presents an in vivo technique to clarify the particle flow paths in the brain and make quantification possible. The method is simple and does not require continuous blood or lymph sampling. Our work shows that there is a substantial flow of injected material from the brain via lamina cribriformis to the lymphatic system. This route is of great interest for the drainage of the interstitial fluid of the brain. We have also shown a difference in flow for dextran particles with different charge.     

乳腺癌前哨淋巴结的探测

目的　评价生物染料、99Tcm 硫胶体及 2种方法联合探测前哨淋巴结 (SLN)的临床效果。方法　 71例早期乳腺癌患者 ,年龄 (5 5 .18± 11.79,34～ 85 )岁 ,采用生物染料 (亚甲蓝、isosulfanblue)、99Tcm 硫胶体及联合探测。以手术切除后淋巴结病理检查作为评价标准。结果　 71例患者中6 0例定位成功。亚甲蓝组探测SLN的检出率、准确性、灵敏度和假阴性率分别为 75 0 % ,83 3% ,70 0 %和 30 0 % ;isosulfanblue组分别为 86 2 % ,96 0 % ,90 0 %和 10 0 % ;99Tcm 硫胶体组 8例中检出SLN 7例 ,真阳性、假阴性和真阴性分别为 1,0和 6例 ;99Tcm 硫胶体 +isosulfanblue组 10例均检出SLN ,真阳性、假阴性及真阴性分别为 3,0和 7例。结论　SLN探测可较准确地反映腋淋巴结的组织学特点 ,染料和99Tcm 硫胶体联合应用可提高SLN检出率、准确性和灵敏度 ,降低假阴性率。     

Fluid balance and pulmonary functions during and after coronary artery bypass surgery: Ringer's acetate compared with dextran, polygeline, or albumin

The effects on fluid balance, pulmonary tunctions and economics were evaluated in a randomized comparison of one colloid free and three colloid containing fluid regimens, for 48 hours during and after coronary artery-bypass (CAB) surgery. A standard regimen for anaesthesia, extracorporeal circulation and monitoring was used. Only Ringer's acetate (RAc) was used as priming solution for extracorporeal circulation. Forty patients were randomized to receive either RAc, polygeline 35 mg-ml^-1 (Haemaccel®), dextran 70 (Macrodex®) 60 mg ml^-14, or albumin 40 mg-ml^-1 in saline whenever fluid volume was needed to stabilize haemodynamics. At the end of the operation, fluid retention was significantly lower in patients receiving polygeline and dextran 70, compared with patients receiving RAc. At 48 hours, however, there were no differences in cumulative fluid balance. Patients in the colloid groups postoperatively had a higher serum colloid osmotic pressure (s-COP), bui a higher net lung capillary filtration pressure (AP) only on the second postoperative day than the RAc group. However, this did not adversely atfect intrapulmonary venous admixture, arterial oxygen tension, or time on respirator in the RAc group compared with the colloid groups. The most expensive colloid fluid regimen (albumin) cost about 230 USS more per patient than the RAc fluid regimen. We conclude that Ringer's acetate for volume replacement to stabilize haemodynamics during and after CAB surgery is associated with increased fluid retention only during the intraoperative period, compared with dextran 70 or polygeline, and with a lower serum colloid osmotic pressure and net lung capillary filtration pressure postoperatively, compared with all three colloid groups. This does not affect pulmonary functions adversely. Thus, the RAc regimen is clinically fully acceptable and economically more favourable than the polygeline, dextran 70, and albumin-containing fluid regimens.     

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

Objective To compare the colloids 5% albumin, 4% gelatin, and 6% HES 130/0.4 with one another and with normal saline regarding their plasma expanding effects at increased permeability and to compare the results with those from a previous study at normal permeability. Design and setting Prospective controlled randomized laboratory study in a university research laboratory. Subjects 48 adult male Sprague-Dawley rats. Interventions Permeability was increased by an injection of 0.5 ml dextran 70 using the fact that dextran causes anaphylactic reaction in the rat. Plasma volume was determined (¹²⁵I albumin tracer technique) after anesthesia, 1 h after dextran injection (before infusion for 10–15 min of 20 ml/kg bw of each of the colloids or 80 ml/kg saline), and 3 h later. Blood pressure, hematocrit, blood gases, and electrolytes were measured. CVP was measured in four rats. Measurements and results Plasma volume was 41.1 ± 1.9 ml/kg at baseline (n = 9), and 29.1 ± 4.1 ml/kg (n = 35) 1 h after the dextran injection. Three hours after infusion of the plasma expander plasma volume had increased by 17.1 ± 3.4 ml/kg in the albumin group, 7.9 ± 3.6 ml/kg in the gelatin group, 7.4 ± 4.4 ml/kg in the HES group, and 12.2 ± 3.1 ml/kg in the saline group. It was unchanged in a control group given no solution (n = 7 for all groups). Conclusion Albumin was a more effective plasma volume expander than gelatin or HES or saline (saline in 4 times larger volume). Gelatin and HES were equally effective. All solutions showed a smaller plasma expanding effect than observed in a previous study with normal permeability.     

不同血浆代用品体外循环预充对3岁以下婴幼儿肝功能及凝血功能的影响

目的 探讨6%羟乙基淀粉130/0.4(万汶)和琥珀酰明胶(血定安)预充对于3岁以下先天性心脏病(先心病)手术患儿肝功能及凝血功能的影响. 方法 45例年龄≤3岁的非紫绀型先心病患者,按照随机数字法分为3组:羟乙基淀粉组(H组)、琥珀酰明胶组(G组)和血浆对照组(C组),每组15例.分别于术前(T0)、术后2 h(T1...     

The significance of colloid osmotic pressure measurement after crystalloid and colloid infusions

Colloid osmotic pressure (COP) was followed postoperatively in 55 randomized patients. After minor operations and short-term infusion therapy only small changes of the COP could be observed and it was concluded that after such operation COP measurement is unnecessary. After major surgical interventions, however, COP measurement gave valuable hints. It was shown that even in the case of moderate blood loss replaced by crystalloids an abnormally low COP did not occur. The same applied also to preoperative hemodilution. It was unnecessary to substitute the withdrawn blood with a colloid solution. In addition, COP measurement helped to avoid expensive albumin administrations and indicated colloid overload in cases of pulmonary edema.