Dubniks Maris, Grände Per-Olof
Department of Anesthesiology and Intensive Care, University and University Hospital of Lund, Sweden.
Microvasc Res. 2008 Aug;76(2):75-9. doi: 10.1016/j.mvr.2008.04.006. Epub 2008 May 13.
Fluid substitution is important in critically ill patients to maintain normovolemia, but there is always a risk that the treatment is too aggressive resulting in fluid overload, or is insufficient with maintenance of hypovolemia. The present study on the rat aims at evaluating the change in plasma volume after 2.5 h from a state of hyper- and hypovolemia. The analysis was made without and with noradrenalin infusion, based on the fact that noradrenalin infusion is a common drug to maintain an adequate arterial pressure, and noradrenalin may induce transcapillary filtration. Plasma volume was determined at baseline and at the end of the experiments with a (125)I-albumin tracer technique. Arterial and central venous pressure, and urine output were recorded. We showed that induction of hypervolemia with a 5% albumin solution (15 ml/kg) resulted in successive loss of plasma volume, which was aggravated with noradrenalin infusion. Hypovolemia induced by hemorrhage (15 ml/kg) resulted in transcapillary absorption, an absorption almost abolished during noradrenalin infusion. There was no plasma volume loss in the sham group. Urine output was higher under hypervolemia than under normovolemia, which in turn was higher than under hypovolemia. We conclude that hypervolemia induces plasma volume loss, which is aggravated by noradrenalin infusion. The compensatory absorption effect after hemorrhage is counteracted by noradrenalin. The results can be explained by differences in hydrostatic capillary pressure via alterations in arterial and venous pressure, according to the 2-pore theory of transcapillary fluid exchange.
液体替代对于危重症患者维持正常血容量很重要,但治疗总是存在风险,即治疗过于激进会导致液体过载,或者治疗不足会导致血容量过低。本项针对大鼠的研究旨在评估从高血容量和低血容量状态开始2.5小时后血浆容量的变化。基于去甲肾上腺素输注是维持足够动脉压的常用药物且去甲肾上腺素可能诱导跨毛细血管滤过这一事实,在未输注和输注去甲肾上腺素的情况下进行了分析。使用(125)I - 白蛋白示踪技术在基线和实验结束时测定血浆容量。记录动脉压、中心静脉压和尿量。我们发现,用5%白蛋白溶液(15毫升/千克)诱导高血容量会导致血浆容量持续减少,而去甲肾上腺素输注会使这种情况加剧。出血(15毫升/千克)诱导的低血容量会导致跨毛细血管吸收,在输注去甲肾上腺素期间这种吸收几乎消失。假手术组没有血浆容量减少。高血容量时的尿量高于正常血容量时,正常血容量时又高于低血容量时。我们得出结论,高血容量会导致血浆容量减少,而去甲肾上腺素输注会使其加剧。出血后的代偿性吸收作用会被去甲肾上腺素抵消。根据跨毛细血管液体交换的双孔理论,这些结果可以通过动脉压和静脉压改变导致的毛细血管静水压差异来解释。