Assessment of hemodynamic and gastric mucosal acidosis with modified fluid gelatin versus 6% hydroxyethyl starch:: a prospective, randomized study
Assessment of hemodynamic and gastric mucosal acidosis with modified fluid gelatin versus 6% hydroxyethyl starch:: a prospective, randomized study
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DOI：
10.1007/s001340000606
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发表时间：
2000-09-01
影响因子：
38.9
通讯作者：
Alquier, P
中科院分区：
文献类型：
--
作者：
Asfar, P;Kerkeni, N;Alquier, P
目的：研究4%琥珀酰化改性液体明胶（MFG）与平均体重相比，高取代6%羟乙基淀粉（HES）对脓毒性低血容量患者血液动力学和胃粘膜酸中毒变量的影响。设计：前瞻性、随机、临床研究。设置：大学医院重症监护室。患者：34例脓毒性低血容量通气和血流动力学控制的患者。干预措施：侵入性血液动力学和胃张力测量。测量和结果：在基线和输注500 ml每种胶体后60 min记录血流动力学和眼压参数。在所有患者中，中心静脉压、肺动脉闭塞压、心脏指数和平均动脉压均显著增加，血红蛋白浓度下降相同，而氧输送保持稳定。使用MFG时，胃粘膜内pH值从7.27 +/- 0.08升高至7.31 +/- 0.07（p < 0.001），使用HES时，胃粘膜内pH值从7.26 +/- 0.11非显著性降低至7.22 +/- 0.08（ns）。二氧化碳胃粘膜动脉压差从18 +/- 9降至13 +/- 9 mmHg（p < 0.0005），而使用羟乙基淀粉后，血压从18 +/- 11 mmHg无显著性升高至21 +/- 11 mmHg。结论：虽然MFG和6%HES具有相同的血流动力学效应，它们的物理化学性质在脓毒症、低血容量和通气患者中诱导对胃粘膜酸中毒的不同反应。在患者管理中需要考虑MFG和HES对胃粘膜的这些影响。
Objective:To investigate the effect of 4% succinylated modified fluid gelatin (MFG) versus mean weight, highly substituted 6% hydroxyethyl starch (HES) on hemodynamic and gastric mucosal acidosis variables, in septic hypovolemic patients.Design: Prospective, randomized, clinical investigation.Setting: University hospital intensive care unit.Patients: Thirty-four septic hypovolemic ventilated and hemodynamically controlled patients.Interventions: Invasive hemodynamic and gastric tonometric measurements.Measurements and results: Hemodynamic and tonometric parameters were recorded at baseline and 60 min after infusion of 500 ml of each colloid. In all patients central venous pressure, pulmonary artery occlusion pressure, cardiac index and mean arterial pressure increased significantly with both colloids, and hemoglobin concentration decreased by the same amount while oxygen delivery remained stable. Gastric intramucosal pH increased from 7.27 +/- 0.08 to 7.31 +/- 0.07 (p < 0.001) with MFG and decreased non-significantly from 7.26 +/- 0.11 to 7.22 +/- 0.08 (ns) with HES. Carbon dioxide gastric mucosal arterial gradient decreased from 18 +/- 9 to 13 +/- 9 mmHg (p < 0.0005) in the MFG group and rose non-significantly from 18 +/- 11 to 21 +/- 11 mmHg with HES.Conclusions: Although MFG and 6% HES have the same hemodynamic effects, their physicochemical properties induce different responses on gastric mucosal acidosis in septic, hypovolemic and ventilated patients. These effects of MFG and HES on gastric mucosa need to be considered in patient management.