Serebriĭskiĭ I I, Galstian G M, Borovkova N B, Gorodetskiĭ V M
Anesteziol Reanimatol. 2006 Mar-Apr(2):48-53.
The prospective study explored the hemodynamic effects of colloidal solution replacement therapy and the criteria for its safety in patients with acute lung parenchymatous lesions (ALPL) attended by hypoalbuminemia and coagulopathy. There were 68 observations of the effects of colloidal solutions: 20% albumin solution (n=25), freshly frozen plasma (FFP) (n=20), 6% hydroxyethylated starch (HES) 130/0.4 9:1 (n=23). The colloidal solutions were infused at a constant rate; the infusion was stopped until pulmonary wedge pressure (PWP) was 25% greater than its baseline value. Before and after infusion, the parameters of central hemodynamics and oxygen transport, extravascular lung water index (ELWI), pulmonary vascular permeability index (PVPI), and colloid-osmotic pressure (COP) were measured. The infusion volumes were 3.8 +/- 0.4, 13.7 +/- 1.4, and 13.4 +/- 1.3 ml/kg for 20% albumin solution, 6% HES 130/0.4, and FFP, respectively. The PWP-COP gradient increased in all groups. After FFP infusion, there was an increase in ELWI and lung shunt. After 20% albumin solution, there was a delayed increase in ELWI. There was no rise in ELWI after 6% HES administration. In the 20% albumin solution group, the increased ELWI was recorded in patients who had positive baseline PWP-COP gradients (p < 0.05). A combination of higher PVPI and a positive PWP-COP value causes a greater increase in ELWI after 20% albumin solution infusion than in the normal PVPI group. In patients with ALPL, FFP infusion may lead to an increase in the accumulation of extravascular lung water. A negative preinfusion PWP-COP gradient is a safety criterion for the infusion of 20% albumin solution in patients with ALPL. The increased PVPI in combination with a positive PWP-COP gradient is an aggravating factor.
这项前瞻性研究探讨了胶体溶液替代疗法对合并低白蛋白血症和凝血病的急性肺实质病变（ALPL）患者的血流动力学影响及其安全性标准。共对68例胶体溶液的效果进行了观察：20%白蛋白溶液（n = 25）、新鲜冰冻血浆（FFP）（n = 20）、6%羟乙基淀粉（HES）130/0.4 9:1（n = 23）。以恒定速率输注胶体溶液；输注直至肺楔压（PWP）比其基线值高25%时停止。输注前后，测量中心血流动力学和氧输送参数、血管外肺水指数（ELWI）、肺血管通透性指数（PVPI）和胶体渗透压（COP）。20%白蛋白溶液、6% HES 130/0.4和FFP的输注量分别为3.8±0.4、13.7±1.4和13.4±1.3 ml/kg。所有组的PWP-COP梯度均升高。输注FFP后，ELWI和肺分流增加。输注20%白蛋白溶液后，ELWI延迟增加。给予6% HES后ELWI未升高。在20%白蛋白溶液组中，基线PWP-COP梯度为正值的患者记录到ELWI升高（p < 0.05）。与正常PVPI组相比，较高的PVPI和正值的PWP-COP值相结合会导致输注20%白蛋白溶液后ELWI升高幅度更大。在ALPL患者中，输注FFP可能导致血管外肺水积聚增加。输注前PWP-COP梯度为负值是ALPL患者输注20%白蛋白溶液的安全标准。PVPI升高与正值的PWP-COP梯度相结合是一个加重因素。
