Influence of different volume therapy regimens on regulators of the circulation in the critically ill (Retracted Article)
Influence of different volume therapy regimens on regulators of the circulation in the critically ill (Retracted Article)
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DOI：
10.1093/bja/77.4.480
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发表时间：
1996-10-01
影响因子：
9.8
通讯作者：
Hempelmann, G
中科院分区：
文献类型：
--
作者：
Boldt, J;Mueller, M;Hempelmann, G
各种血管活性物质参与宏观和微循环的调节。我们研究了在创伤和脓毒症患者中使用人血白蛋白（HA）或羟乙基淀粉溶液（HES）进行长期容量治疗期间，这些调节因子是否发生变化。为了将肺毛细血管楔压（PCWP）维持在10-15 mm Hg，输注20% HA（HA-创伤，n=14; HA-脓毒症，n=14）或10%低分子量羟乙基淀粉溶液（羟乙基淀粉-创伤，n=14;羟乙基淀粉-脓毒症，n=14）5天，否则两组（创伤/脓毒症）之间的患者管理没有差异。监测平均动脉压（MAP）、心率（HR）、PCWP和心脏指数（CI）。使用单乙基甘氨酰二甲基苯胺（MEGX）试验评估肝功能，并通过张力测定法监测胃粘膜内pH（pH（i）），以评估内脏灌注。从动脉血样本中测量血管加压素、内皮素-1、肾上腺素、去甲肾上腺素、心房利钠肽和6-酮-前列腺素F-1 α的血浆浓度。所有测量均在入住重症监护室（创伤患者）当天或诊断脓毒症时进行，并在接下来的5天每天12：00进行。MAP、HR和PCWP在相应亚组（创伤/脓毒症）之间没有差异。HES组CI增加显著高于HA组。在整个研究过程中，创伤患者的pH（i）和MEGX血浆浓度没有差异。脓毒症组两者均低于正常值，而HES组高于白蛋白治疗组（P
Various vasoactive substances are involved in the regulation of the macro- and microcirculation. We have investigated if these regulators change during long-term volume therapy with human albumin (HA) or hydroxyethylstarch solution (HES) in trauma and sepsis patients. To maintain pulmonary capillary wedge pressure (PCWP) at 10-15 mm Hg, either 20% HA (HA-trauma, n=14; HA-sepsis, n=14) or 10% low-molecular weight HES solution (HES-trauma, n=14; HES-sepsis, n=14) were infused for 5 days, otherwise patient management did nor differ between the two groups (trauma/sepsis). Mean arterial pressure (MAP), heart rate (HR), PCWP and cardiac index (CI) were monitored In all patients. Liver function was assessed using the monoethylglycinexylidide (MEGX) test, and gastric intramucosal pH (pH(i)) was monitored by tonometry to assess splanchnic perfusion. Plasma concentrations of vasopressin, endothelin-1, adrenaline, noradrenaline, atrial natriuretic peptide and 6-keto-prostaglandin F-1 alpha were measured from arterial blood samples. All measurements were carried out on the day of admission to the intensive care unit (trauma patients) or on diagnosis of sepsis, and daily over the next 5 days at 12:00. MAP, HR and PCWP did not differ between the corresponding subgroups (trauma/sepsis). CI increased significantly more in the HES than in the HA groups. pH(i) and MEGX plasma concentrations did not differ in the trauma patients throughout the study. Both were lower than normal in the sepsis groups and increased more markedly in the HES than in the albumin-treated patients (P