Hofmann D, Thuemer O, Schelenz C, van Hout N, Sakka S G
Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Jena, Germany.
Acta Anaesthesiol Scand. 2005 Oct;49(9):1280-6. doi: 10.1111/j.1399-6576.2005.00834.x.
Sufficient cardiac pre-load for maintaining adequate cardiac output is a major goal in the treatment of critically ill patients. We studied the effects of increasing cardiac output by fluid loading on the indocyanine green plasma disappearance rate (ICG-PDR) and gastric mucosal regional CO2 tension (PRco2) as an indicator of splanchnic microcirculation.
With approval by our ethics committee and written consent, we studied post-operatively 12 patients (1 female, 11 males; 66 +/- 13 years) with elective coronary artery bypass grafting (n = 10) or aortic valve replacement (n = 2). All patients had received pulmonary artery and left atrial catheterization previously for clinical indications. Cardiac output and filling pressures were measured immediately after intensive care unit (ICU) admission and 1 h after the beginning of fluid loading.
Overall, 630 +/- 130 ml of 6% hydroxyethylstarch (130 kDa) was infused with the splanchnic perfusion pressure remaining constant. Norepinephrine and epinephrine dosages were unchanged. The cardiac index increased significantly from 2.8 +/- 0.7 to 3.5 +/- 0.6 l/min/m2 and the stroke volume index from 30 +/- 7 to 38 +/- 8 ml/m2. ICG-PDR showed no significant change, i.e. from 21.2 +/- 6.5 to 21.6 +/- 6.5%/min. Gastric mucosal PRco2 and the Pco2 gap (difference between regional and end-tidal CO2 tension) were constant, i.e. changed from 5.1 +/- 0.8 to 5.5 +/- 1.1 kPa and from 0.9 +/- 0.5 to 1.0 +/- 0.7 kPa, respectively.
Increasing cardiac output to supranormal values by fluid loading is not associated with a significant change in ICG-PDR or gastric mucosal PRco2.
维持足够的心输出量所需的充足心脏前负荷是重症患者治疗的主要目标。我们研究了通过液体负荷增加心输出量对吲哚菁绿血浆消失率（ICG-PDR）和胃黏膜局部二氧化碳张力（PRco2）的影响，后者作为内脏微循环的指标。
经伦理委员会批准并获得书面同意后，我们对12例择期冠状动脉搭桥术（n = 10）或主动脉瓣置换术（n = 2）的患者（1例女性，11例男性；66±13岁）进行了术后研究。所有患者此前因临床指征均接受过肺动脉和左心房导管插入术。在重症监护病房（ICU）入院后即刻以及液体负荷开始后1小时测量心输出量和充盈压。
总体而言，输注了630±130 ml的6%羟乙基淀粉（130 kDa），内脏灌注压保持恒定。去甲肾上腺素和肾上腺素剂量未改变。心脏指数从2.8±0.7显著增加至3.5±0.6 l/min/m²，每搏量指数从30±7增加至38±8 ml/m²。ICG-PDR无显著变化，即从21.2±6.5变为21.6±6.5%/min。胃黏膜PRco2和Pco2差值（局部与潮气末二氧化碳张力之间的差值）保持恒定，分别从5.1±0.8变为5.5±1.1 kPa以及从0.9±0.5变为1.0±0.7 kPa。
通过液体负荷将心输出量增加至超常值与ICG-PDR或胃黏膜PRco2的显著变化无关。
