Rittoo D, Gosling P, Bonnici C, Burnley S, Millns P, Simms M H, Smith S R G, Vohra R K
Department of Vascular Surgery, Biochemistry, Anaesthetics and Intensive Care, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Raddlebarn Road, Selly Oak, Birmingham B29 6JD, UK.
Cardiovasc Surg. 2002 Apr;10(2):128-33. doi: 10.1016/s0967-2109(01)00132-6.
Gastric intramucosal pH (pHi), a surrogate marker of splanchnic oxygenation, falls following abdominal aortic aneurysm surgery.
To investigate the effects of volume expansion with hydroxyethyl starch (eloHAES) on splanchnic perfusion compared to another colloid such as gelofusine.
Twenty-two consecutive patients undergoing AAA repair were randomised to receive either eloHAES or gelofusine as plasma expanders. Tissue oxygenation was monitored (10 gelofusine and 12 eloHAES) indirectly by measuring pHi using a nasogastric tonometer.
Compared to the eloHAES group, the fall in pHi was significantly greater in the gelofusine group at clamp release (7.29 vs 7.33, P=0.003) and at 4 h following clamp release (7.29 vs 7.33, P=0.03). There was a good inverse correlation between the lowest pHi and the peak serum interleukin-6 (r(s)= -0.47, P=0.03). By multivariate analysis, the only factor that influenced the pHi was the type of colloid used (F=5.54, P=0.005). The eloHAES treated patients required significantly less colloid on the first postoperative day (3175 +/- 175 vs 4065 +/- 269 ml, P=0.01).
In patients undergoing abdominal aortic aneurysm repair, plasma expansion with eloHAES improves microvascular perfusion and splanchnic oxygenation.
胃黏膜内pH值（pHi）是内脏氧合的替代指标，在腹主动脉瘤手术后会下降。
研究与另一种胶体如琥珀明胶相比，羟乙基淀粉（万汶）扩容对内脏灌注的影响。
连续22例接受腹主动脉瘤修复术的患者被随机分为接受万汶或琥珀明胶作为血浆扩容剂。通过使用鼻胃张力计测量pHi间接监测组织氧合（10例使用琥珀明胶，12例使用万汶）。
与万汶组相比，琥珀明胶组在松开血管夹时（7.29对7.33，P = 0.003）和松开血管夹后4小时（7.29对7.33，P = 0.03）pHi的下降幅度明显更大。最低pHi与血清白细胞介素-6峰值之间存在良好的负相关（r(s)= -0.47，P = 0.03）。通过多因素分析，影响pHi的唯一因素是所用胶体的类型（F = 5.54，P = 0.005）。接受万汶治疗的患者术后第一天所需胶体明显较少（3175±175对4065±269 ml，P = 0.01）。
在接受腹主动脉瘤修复术的患者中，使用万汶进行血浆扩容可改善微血管灌注和内脏氧合。
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