Background. Extreme hemodilution caused by relatively large prime volumes required for cardiopulmonary bypass in infants causes a dilutional coagulopathy, characterized by low concentrations of fibrinogen and other circulating coagulation factors. Modified ultrafiltration results in hemoconcentration and is associated with decreases in postoperative bleeding and transfusion requirements in children. This study was undertaken to quantify the effect of modified ultrafiltration on concentrations of fibrinogen, plasma proteins, and platelets in infants and small children.
Methods. Twenty patients less than 15 kg were studied. Cardiopulmonary bypass circuits were primed with crystalloid solutions. Red blood cells were added during cardiopulmonary bypass for hematocrits less than 15%. Colloid solutions were not administered. Concentrations of fibrinogen, plasma proteins, and platelets, and hematocrit were measured before cardiopulmonary bypass, before modified ultrafiltration, and after modified ultrafiltration.
Results. Modified ultrafiltration was associated with significant (p < 0.001) increases in hematocrit (19% ± 6% to 31% ± 9%), fibrinogen (65 ± 29 to 101 ± 45 mg/dL), and total plasma proteins (2.7 ± 0.3 to 4.9 ± 0.7 g/dL), but no change (p = 0.129) in platelet count.
Conclusions. We conclude that modified ultrafiltration significantly attenuates the dilutional coagulopathy associated with cardiopulmonary bypass in infants. 相似文献
Objective: Kinetics of piperacillin (pip), in combination with the beta-lactamase inhibitor tazobactam (taz) have been studied in volunteers
and patients in relatively stable conditions. The fixed drug preparation appeared to have ideal pharmacokinetic properties
if renal function was normal or slightly impaired, but no data are available for critically ill patients in anuric renal failure.
This study should provide such data. Patients, design: We studied the pharmacokinetics in nine patients with multiple organ failure, including anuric renal failure, treated with
continuous veno-venous hemofiltration (CVVH). Patients received a standard schedule of 4 g pip and 0.5 g taz administered
over 0.5 h intravenously, 8 hourly. During 2 consecutive days, the serum levels of both compounds were determined, and total
clearance (CIT) was calculated from serum concentrations. Results: All nine patients completed day 1, and 8 completed day 2 of the protocol. On day 1, single-dose kinetics showed considerable
spread, but pip/taz serum levels followed the pattern as expected, with a pip / taz concentration ratio of 20 : 1. On day
2, however, taz serum concentrations showed a relative increase as compared to pip, resulting in a change in the serum pip/taz
concentration ratio to 10 : 1 on day 2. The CIT of pip was 2.52 ± 1.38 l/h (t 1/2 : 5.9 ± 2.9 h), and CIT of taz 4.44 ± 2.28 l/h (t 1/2 : 8.1 ± 3.7 h). The CIT and t 1/2 of pip and taz correlated highly significantly with clearance by CVVH. Despite a higher CIT, taz has a longer half-life, because of a higher volume of distribution. Conclusion: In CVVH dependent patients, pip/taz fixed drug preparations can be used initially, but the pip dosage should be increased
relative to that of taz (or interval-adjusted) to prevent cumulation of taz, as compared to the active antimicrobial agent
pip.
Received: 19 February 1997 Accepted: 20 May 1997 相似文献
目的:探讨暴发性急性胰腺炎的治疗方法.方法:回顾性分析从1991年1月至2005年12月收治的38例暴发性急性胰腺炎病例,分为急诊手术治疗、非手术治疗和非手术治疗结合早期手术治疗3细观察疗效.结果:38例中存活24例,总体生存率为63.16%,其中急诊手术治疗10例,存活4例(40%);单纯非手术治疗组16例,存活9例(56.25%);非手术治疗结合早期手术治疗治疗组12例,存活11例(91.67%).3组存活率两两比较其差异具有显著性(P<0.05);3组的急性生理学和慢性健康评分标准APCHEⅡ(acute physiology and chronic health evaluationⅡ)评分两两比较均不具有显著性差异(P>0.05).结论:对于暴发性急性胰腺炎应在强化的非手术监护治疗下行早期手术治疗,腹腔间隔室综合征的发展程度是决定手术时机的关键;手术目的是进行充分有效的腹腔减压和引流而不是以清除胰腺的坏死组织为目的;术后血液透析对于阻止胰腺局部病变和全身病情加重,保护脏器功能具有显著功能. 相似文献
The aim of our study was to examine renal replacement therapies (RRT) that have been used for acute renal failure (ARF) in our intensive care unit (ICU) patients and to compare their outcomes. Sixteen patients who underwent intermittent hemodialysis (IHD), 14 patients who underwent continuous hemofiltration (CHF) in combination with IHD (CHF + IHD), and 38 patients who underwent continuous hemodiafiltration (CHDF) were evaluated. Regarding the effects of blood purification on hemodynamics and renal function, the percentage increase in blood pressure and percent rapid increase in urinary output were the greatest in the CHDF group. The hourly urinary output after the start of initial blood purification increased only in the CHDF group. The survival rate was significantly higher in the CHDF group. These results suggest that CHDF should be the first-line therapy for patients with ARF and that we are moving in the right direction regarding the application of RRT to treat ARF in ICU patients. 相似文献
Acute renal failure (ARF) requiring hemodialysis after percutaneous coronary interventions (PCI) is a serious complication with poor prognosis. Hemodialysis-induced hypotension may have deleterious cardiovascular effects, especially in high-risk patients. Ultrafiltrate removal and simultaneous fluid replacement with a solution similar to plasma for high-volume controlled hydration can be obtained with hemodynamic stability by continuous veno-venous hemofiltration (CVVH). We prospectively assessed the safety and effectiveness of percutaneous CVVH (Y-shaped double-lumen catheter, circuit originating from and terminating in the femoral vein) in 33 consecutive patients (23 men and 10 women; mean age, 69 +/- 9 years) who, after PCI, developed oligo-anuric ARF, associated in 20 of them with congestive heart failure. All patients received a concomitant infusion of furosemide (500-1000 mg/day) and dopamine (2 microg/kg/min). During CVVH, the average fluid volume replacement and body fluid net reduction were 1000 +/- 247 and 75 +/- 48 ml/hr, respectively. Treatment with CVVH continued for 4.7 +/- 2.7 days and corrected fluid overload in all cases. No patient experienced systemic hypotension or hypovolemia. Diuresis recovered in 32 (97%) patients, who showed a parallel improvement of renal function parameters. One patient required chronic dialysis. In-hospital and 1-year mortality was 9.1% and 27.3%, respectively. In conclusion, our data indicate that CVVH is a safe and effective therapy of radiocontrast-induced ARF following PCI. It temporarily replaces renal function without deleterious cardiovascular effects, allowing the kidney to recover from the nephrotoxic injury. However, despite promising early results, large randomized trials are required to define the role of CVVH in ARF after PCI. 相似文献