体外循环期间流量增加与液体蓄积有关。
Elevated flow rate during cardiopulmonary bypass is associated with fluid accumulation.
作者信息
Haugen Oddbjørn, Farstad Marit, Kvalheim Venny, Bøe Olav, Husby Paul
机构信息
Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
出版信息
J Thorac Cardiovasc Surg. 2007 Sep;134(3):587-93. doi: 10.1016/j.jtcvs.2007.04.040.
OBJECTIVE
High flow rates during cardiopulmonary bypass are assumed to increase fluid accumulation. This study aimed to determine whether two different flow rates during cardiopulmonary bypass alter the intraoperative fluid balance and extravasation rate.
METHODS
Sixteen pigs underwent 60 minutes of normothermic bypass, followed by 90 minutes of hypothermic bypass. A high-flow group (HF group, n = 8) had a cardiopulmonary bypass flow rate of 110 mL x kg(-1) x min(-1) and a low-flow group (LF group, n = 8) had a rate of 80 mL x kg(-1) x min(-1). Blood chemistry, hemodynamic parameters, plasma and interstitial colloid osmotic pressure, net fluid balance, plasma volume, fluid extravasation rate, and total tissue water content were measured or calculated. Results are presented as mean (standard deviation).
RESULTS
The average net fluid balance during cardiopulmonary bypass was 1.02 (0.25) and 0.73 (0.23) mL x kg(-1) x min(-1) in the HF group and LF group, respectively (P < .05). The average fluid extravasation rate was 0.98 (0.22) and 0.77 (0.22) mL x kg(-1) x min(-1) in the HF group and the LF group (P = .07). Total water content was higher in the kidneys (P < .05) and tended to be higher in the lungs (P = .05), liver (P = .07), and brain (P = .07) of the HF group than in those of the LF group. The between-group differences in net fluid balance and fluid extravasation rate were present during the first 30 minutes of normothermic cardiopulmonary bypass. Thereafter, the values stabilized and remained similar in the two groups. Plasma volume and systemic vascular resistance differed between the groups.
CONCLUSION
Cardiopulmonary bypass flow rate of 110 mL x kg(-1) x min(-1) was associated with higher positive net fluid balance and fluid extravasation rate than 80 mL x kg(-1) x min(-1). The effect was mainly observed in the initial phase of cardiopulmonary bypass.
目的
体外循环期间高流量被认为会增加液体蓄积。本研究旨在确定体外循环期间两种不同流量是否会改变术中液体平衡和外渗率。
方法
16头猪接受60分钟常温体外循环，随后进行90分钟低温体外循环。高流量组（HF组，n = 8）体外循环流量为110 mL×kg⁻¹×min⁻¹，低流量组（LF组，n = 8）流量为80 mL×kg⁻¹×min⁻¹。测量或计算血液化学指标、血流动力学参数、血浆和间质胶体渗透压、净液体平衡、血浆容量、液体外渗率和总组织含水量。结果以均值（标准差）表示。
结果
HF组和LF组体外循环期间的平均净液体平衡分别为1.02（0.25）和0.73（0.23）mL×kg⁻¹×min⁻¹（P <.05）。HF组和LF组的平均液体外渗率分别为0.98（0.22）和0.77（0.22）mL×kg⁻¹×min⁻¹（P =.07）。HF组肾脏的总含水量较高（P <.05），肺部（P =.05）、肝脏（P =.07）和大脑（P =.07）的总含水量也有高于LF组的趋势。在常温体外循环的前30分钟，两组间净液体平衡和液体外渗率存在差异。此后，这些值趋于稳定，两组间保持相似。两组间血浆容量和全身血管阻力不同。
结论
与80 mL×kg⁻¹×min⁻¹相比，110 mL×kg⁻¹×min⁻¹的体外循环流量与更高的正净液体平衡和液体外渗率相关。这种影响主要在体外循环的初始阶段观察到。
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