Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery (Retracted Article)
Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery (Retracted Article)
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DOI：
10.1097/00000539-200108000-00034
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发表时间：
2001-08-01
影响因子：
5.7
通讯作者：
Haisch, G
中科院分区：
文献类型：
--
作者：
Lang, K;Boldt, J;Haisch, G
血管内容量替代方案对组织氧分压(ptio(2))的影响尚不明确。42例择期腹部大手术患者随机分为6%羟乙基淀粉(HES)(平均分子质量130kd，取代度0.4，n=21)和乳酸盐林格液(RL，n=21)进行血管内容量置换。围手术期给予液体，并在重症监护病房持续24小时，以保持中心静脉压在8至12 mm Hg之间。分别于麻醉诱导后(T0)、麻醉诱导后60min(T1)、麻醉诱导后120min(T2)、手术结束时(T3)和重症监护病房(T4)术后第1天早晨，用微量可植入氧导管连续测定左侧三角肌的ptio(2)。HES 130/0.4,2920+/-360毫升和11,740+/-2,630毫升。在整个研究过程中，两个容量组之间的全身血流动力学和氧合(PaO(2)，PaCO(2))没有显著差异。在相似的基线值中，HES治疗的患者ptio(2)显著增加(T4时最大为59%)，而RL组则降低(T4时最大为-23%，P<；0.05)。术后第1天清晨测得pTiO(2)最大差值。我们的结论是，与基于晶体的容量替换策略相比，使用6%HES 130/0.4的血管内容量替换策略在主要外科手术期间和之后改善了组织氧合。在接受HES 130/0.4治疗的患者中，改善的微循环和较少的内皮细胞肿胀可能是导致ptio(2)增加的原因。
The effects of intravascular volume replacement regimens on tissue oxygen tension (ptio(2)) are not definitely known. Forty-two consecutive patients scheduled for elective major abdominal surgery were prospectively randomized to receive either 6% hydroxyethyl starch (HES) (mean molecular weight 130 kd, degree of substitution 0.4, n = 21) or lactated Ringer's solution (RL, n = 21) for intravascular volume replacement. Fluids were administered perioperatively and continued for 24 h on the intensive care unit to keep central venous pressure between 8 and 12 mm Hg. The ptio(2) was measured continuously in the left deltoid muscle by using microsensoric implantable partial pressure of oxygen catheters after the induction of anesthesia (baseline, T0), 60 min (T1) and 120 min thereafter (T2), at the end of surgery (T3), and on the morning of the first postoperative day on the intensive care unit (T4). HES 130/0.4 2920 +/- 360 mL and 11,740 +/- 2,630 mL of RL were given to the patients within the study period. Systemic hemodynamics and oxygenation (Pao(2), Paco(2)) did not differ significantly between the two volume groups throughout the study. From similar baseline values, ptio(2) increased significantly in the HES-treated patients (a maximum of 59% at T4), whereas it decreased in the RL group (a maximum of -23% at T4, P < 0.05). The largest differences of ptio(2) were measured on the morning of the first postoperative day. We conclude that intravascular volume replacement with 6% HES 130/0.4 improved tissue oxygenation during and after major surgical procedures compared with a crystalloid-based volume replacement strategy. Improved microperfusion and less endothelial swelling may be responsible for the increase in ptio(2) in the HES 130/0.4-treated patients.