The use of blood products in shock.

It is often necessary to transfuse blood products in shock. Use of these products can be life-saving, but they also carry considerable risk. It is important, therefore, that the physician be aware of the indications as well as possible complications, so that a proper decision can be made weighing the risk versus the benefit.     

Blood fibronectin level in experimental burn shock

The blood fibronectin concentration in rats was measured by the ELISA during burn shock. Fifteen minutes after burn the fibronectin level was found to drop by 30% of the initial level on the average. Deep hypofibronectinemis lasted up to 24 h after burn. At the same time the clinical and pathomorphological picture of the shock was fairly pronounced. The survived animals demonstrated a progressive normalization of the fibronectin level. The fibronectin level completely returned to normal by the outcome of the second day after burn and then progressed to reactive hyperfibronectinemia by 70-72 h. The data obtained point to the involvement of fibronectin into the pathogenesis of burn shock, which is likely to be connected with the mechanism of reticuloendothelial system dysfunction.     

The use of the mount vernon formula in the treatment of burn shock

Loss of fluid from the blood plasma and subsequent hypovolaemia is the central feature of shock in burning injuries and restoration of blood volume by intravenous transfusion remains the mainstay of treatment. The rate of loss of fluid bears a relationship to the extent of the burn and by use of a formula it is possible to predict the rate of loss at a particular time and the total quantity of fluid necessary. Various different formulae are discussed and the development of a formula in the Burns Ward of the Mount Vernon Centre for Plastic Surgery is described. It is emphasised that the formula is only a guide and the necessity for repeated clinical examination of the patient is stressed. Our reasons are given for the use of reconstituted dried human plasma as the main transfusion fluid.     

血细胞比容及碱剩余评估特重烧伤患者休克复苏效果的临床研究

目的研究血细胞比容及碱剩余评估特重烧伤患者休克复苏效果的临床价值。方法将2012年4月至2014年6月期间就诊的40例特重度烧伤伴休克患者纳入研究对象,入院后接受液体复苏治疗,根据复苏后1 d和2 d时血细胞比容以及碱剩余情况不同分为正常组和异常组。采用酶联免疫吸附法检测白细胞介素4(IL-4)和白细胞介素6(IL-6)、肿瘤坏死因子(TNF-α)。结果复苏后1 d和2 d时,血细胞比容正常组不同时点血比容均明显低于异常组,IL-4、IL-6、TNF-α含量均低于血细胞比容异常组;碱剩余正常组不同时点碱剩余含量均明显高于对照组,IL-4、IL-6、TNF-α含量均低于碱剩余异常组。结论血细胞比容越低、碱剩余越高,特重烧伤患者休克复苏后的炎症反应越弱、复苏效果越好;血细胞比容及碱剩余是评估复苏效果的理想指标。     

Effective limitation of blood culture use in the burn unit

There is little data to support the use of blood culture (BC) testing in the burn patient. Clinical signs (fever, leukocytosis) may not reliably indicate infection; moreover, BC's are expensive, invasive and plagued by false positive results. A policy of critical evaluation of lab utilization was instituted in our burn unit in 1993. By 1997 the use of blood culture testing had decreased by 50%. A retrospective analysis of our change in BC utilization was undertaken to derive practice guidelines for usage of this test. METHODS: 47 patients with BC testing in 1997 were compared to a cohort of 47 patients from 1993, representing a total of 441 BC episodes. RESULTS: Comparison of 1993 and 1997 patients revealed no significant differences in patient characteristics or outcomes. The mean white blood cell count and maximum temperature on the day of culture were identical for both positive and negative BC episodes. However, BC's drawn during a state of shock were twice as likely to be positive. Patients who experienced positive BC's had larger burns, received more antibiotics, had more indwelling catheters, and had longer lengths of ventilator support and hospital stays. CONCLUSIONS: Higher patient acuity or the presence of indwelling catheters increases the likelihood of a positive BC. Substantial limitation of BC's without observed changes in length of stay, ventilator days, or mortality suggests that this test can be safely limited without compromising patient outcomes.     

一次性血液净化输液管路的临床实验研究

目的观察自行设计的一次性血液净化输液管路在临床使用中的效果。方法选择200例次需进行连续性血液净化的病人随机分成两组,实验组100例次,使用自行设计的一次性输液管路串联到与透析机配套的原装置换液输入管路上进行治疗;对照组100例次,直接使用透析机的原装配套的置换液输入管路进行治疗。比较两组治疗病例在同一单位时间内更换置换液的时间、频率;管路及滤器凝血情况以及病人血电解质、pH值的变化。结果实验组在同一单位时间内更换置换液的时间及频率明显少于对照组;管路及滤器凝血现象也少于对照组。两组病例在治疗过程中的血电解质与pH值无明显变化。结论使用该一次性血液净化输液管路能减少连续性血液净化过程中护士更换液袋的频率,节约了护士的人力,避免了频繁换袋可能导致的操作污染,减少了治疗过程中管路及滤器凝血现象。     

Subcutaneous and liver tissue oxygen tension in hemorrhagic shock: an experimental study with whole blood and two colloids

Because it is difficult to verify the efficacy of hemorrhagic shock treatment, we compared subcutaneous O2 tension (PscO2) with liver oxygenation in efforts to correct shock in piglets with two different colloids, hydroxyethyl starch (HES-120) and dextran-70. Nineteen animals were bled to shock and the shed blood was retransfused in the control group. Liver oxygenation was measured directly by means of a silicone tube used as a tonometer, and indirectly by calculating liver O2 consumption (VO2). PscO2 was monitored with a needle electrode. The two colloid groups were compared by measuring plasma lactate, and the plasma colloid osmotic pressure (COPp). PscO2 followed closely the changes in liver tissue PO2 during the experiment; it seems to be a useful tool in estimating volume filling during the treatment of hemorrhagic shock. A wider variation was noted in calculated liver VO2 compared with hepatic venous PO2 or liver tissue PO2. Despite the fact that COPp increased to a higher level after the administration of dextran, HES proved to be at least as effective as dextran in restoring mean arterial pressure, cardiac output, liver oxygenation, PscO2, arterial pH, arterial plasma lactate, and liver lactate uptake.     

Infusion therapy for burn shock in children

The study deals with infusion therapies in children with thermal injury and with its impact of its qualitative composition at the local (tissue) and systemic levels. The investigations have indicated that the best qualities' in replenishing the volume of circulating blood and in eliminating hypovolemia are shown by hydroxyethylated starch (the study used voluvene) that offers advantages in the rate of correction of blood concentrations and in the maintenance of a volumic effects and that increases oxygen delivery, resulting in a rapider emergency from shock and improving the trophism of a burn wound.     

应用紧急输血绿色通道救治60例失血性休克患者

优化、完善输血流程管理,形成规范、合理的紧急输血绿色通道流程模式,并于2007年5月至2010年5月采用该流程救治63例失血性休克患者,输血时间较前缩短了35min。认为紧急输血绿色通道流程是医院为危急重症惠者提供的快速、高效的服务系统。     

Influence of continuous haemofiltration on haemodynamics and central blood volume in experimental endotoxic shock

In order to asses the influence of continuous haemofiltration (HF) on haemodynamics and central blood volume in endotoxic shock, endotoxinaemia was invoked in 20 swine (28–32 kg). 15 min after doubling the mean pulmonary pressure, the animals were randomly assigned to receive either a zero-balanced veno-venous HF with an ultrafiltration and replacement rate of 600 ml/h (HF group,n=10) or to observe the spontaneous course (E group,n=10) under a constant infusion of endotoxin for 4h. A trend to a higher survival rate in the HF group (6/10 vs. 3/10; group) during the observation period was evident, but not statistically significant. Early initiation of HF during endotoxic shock modifies the haemodynamic response, lowering the pulmonary artery pressure (PAP), PCWP, pulmonary (PVR) and systemic vascular resistance (SVR), compared to the spontaneous course, whereas the decrement of central blood volume was comparable in both groups. These changes cannot be explained by effects of the HF on the volume status, but supports and additional effect by the filtration of small and medium-sized molecules.