Boldt J, Kling D, Herold C, Dapper F, Hempelmann G
Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, FRG.
Anaesthesia. 1990 Nov;45(11):928-34. doi: 10.1111/j.1365-2044.1990.tb14621.x.
The ideal solution for volume therapy remains controversial. In cardiac surgery, haemodynamic efficacy as well as the influence of extracorporeal oxygenation are of major interest when administering volume. The present study examines the effects of a new hypertonic saline hydroxyethyl starch solution in comparison to a 6% hydroxyethyl starch solution on haemodynamics and laboratory variables. Patients scheduled for elective aortocoronary bypass grafting received hypertonic saline hydroxyethyl starch (n = 10) or hydroxyethyl starch (n = 10) after induction of anaesthesia in order to double baseline pulmonary capillary wedge pressure. Ten patients without volume therapy served as a control group. Significantly less hypertonic solution than standard solution was effective in doubling pulmonary capillary wedge pressure. Fluid requirements in the patients who received the hypertonic solution were significantly less during, as well as after, cardiopulmonary bypas in comparison to those in the other groups. Cardiac index increased most in the patients who received the hypertonic solution (+34.8%), as did right ventricular end-diastolic volume. Patients in that group showed the highest decrease in total systemic resistance (-29.8%), whereas arterial pressure and right ventricular ejection fraction remained almost unchanged in all groups. No negative alteration in coagulation or organ function was demonstrated within the investigation period. It can be concluded that hypertonic saline hydroxyethyl starch solution seems to be a valuable alternative to conventional volume therapy in cardiac surgery.
容量治疗的理想解决方案仍存在争议。在心脏手术中，给药时血流动力学疗效以及体外氧合的影响是主要关注点。本研究比较了一种新型高渗盐水羟乙基淀粉溶液与6%羟乙基淀粉溶液对血流动力学和实验室指标的影响。计划进行择期主动脉冠状动脉搭桥术的患者在麻醉诱导后接受高渗盐水羟乙基淀粉（n = 10）或羟乙基淀粉（n = 10），以使基线肺毛细血管楔压加倍。10名未接受容量治疗的患者作为对照组。与标准溶液相比，显著更少的高渗溶液就能有效使肺毛细血管楔压加倍。与其他组相比，接受高渗溶液的患者在心肺旁路手术期间及术后的液体需求量显著更少。接受高渗溶液的患者心脏指数增加最多（+34.8%），右心室舒张末期容积也是如此。该组患者全身总阻力下降最大（-29.8%），而所有组的动脉压和右心室射血分数几乎保持不变。在研究期间未发现凝血或器官功能有负面改变。可以得出结论，高渗盐水羟乙基淀粉溶液似乎是心脏手术中传统容量治疗的一种有价值的替代方案。
