Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability
Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability
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DOI：
10.1097/00000542-200606000-00018
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发表时间：
2006-06-01
期刊：
影响因子：
8.8
通讯作者：
Becker, Bernhard F.
中科院分区：
文献类型：
--
作者：
Jacob, Matthias;Bruegger, Dirk;Becker, Bernhard F.
背景：液体外渗可能导致心肌水肿，进而导致心室功能下降。据推测白蛋白与内皮糖萼相互作用。作者的目的是比较不同复苏液（人白蛋白、羟乙基淀粉、生理盐水）对血管完整性的影响。方法：在离体灌注心脏模型（豚鼠）中，用胶体（三分之一体积的 5% 白蛋白或 6% 羟乙基淀粉 130/0.4）或晶体（0.9%）增强 Krebs-Henseleit 缓冲液。 生理盐水）。在不同流速下评估灌注压和血管液体滤过（心外膜漏出液形成）。在全面、停流缺血（37℃，20分钟）后，用相同的复苏液添加剂对心脏进行再灌注。在第二个系列中，作者在酶消化内皮糖萼（肝素酶，10 U，15 分钟内）后应用了各自的灌注液。结果：与盐水相比，5% 白蛋白和 6% 羟乙基淀粉均减少了液体外渗（68.4 +/- 5.9、134.8 +/- 20.5 和 436.8 +/- 14.7 mu l/min，分别在60 cm H2O灌注压力下； P < 0.05），相应的胶体渗透压为2.95、5.45和0.00 mmHg。内皮糖萼的消化降低了两个胶体组的冠状动脉完整性。缺血后，含有羟乙基淀粉和盐水的 Krebs-Henseleit 缓冲液会导致血管渗漏短暂增加，但白蛋白则不会。作者观察到稳定状态下血管内和大量间质胶体浓度没有差异。尽管如此，电子显微镜显示白蛋白组内皮糖萼完整且无间质水肿。结论：离体白蛋白比晶体或人工胶体更有效地防止心脏中的液体外渗。这种效应部分独立于胶体渗透压，可能归因于白蛋白与内皮糖萼的相互作用。
Background: Fluid extravasation may lead to myocardial edema and consequent reduction in ventricular function. Albumin is presumed to interact with the endothelial glycocalyx. The authors' objective was to compare the impact of different resuscitation fluids (human albumin, hydroxyethyl starch, saline) on vascular integrity.Methods: In an isolated perfused heart model (guinea pig), Krebs-Henseleit buffer was augmented with colloids (one third volume 5% albumin or 6% hydroxyethyl starch 130/0.4) or crystalloid (0.9% saline). Perfusion pressure and vascular fluid filtration (epicardial transudate formation) were assessed at different flow rates. After global, stopped-flow ischemia (37 degrees C, 20 min), hearts were reperfused with the same resuscitation fluid additives. in a second series, the authors applied the respective perfusates after enzymatic digestion of the endothelial glycocalyx (heparinase, 10 U over 15 min).Results: Both 5% albumin and 6% hydroxyethyl starch decreased fluid extravasation versus saline (68.4 +/- 5.9, 134.8 +/- 20.5, and 436.8 +/- 14.7 mu l/min, respectively, at 60 cm H2O perfusion pressure; P < 0.05), the corresponding colloid osmotic pressures being 2.95, 5.45, and 0.00 mmHg. Digestion of the endothelial glycocalyx decreased coronary integrity in both colloid groups. After ischemia, a transient increase in vascular leak occurred with Krebs-Henseleit buffer containing hydroxyethyl starch and saline, but not with albumin. The authors observed no difference between intravascular and bulk interstitial colloid concentration in the steady state. Notwithstanding, electron microscopy revealed an intact endothelial glycocalyx and no interstitial edema in the albumin group.Conclusion: Ex vivo, albumin more effectively prevented fluid extravasation in the heart than crystalloid or artificial colloid. This effect was partly independent of colloid osmotic pressure and may be attributable to an interaction of albumin with the endothelial glycocalyx.