Hammersborg Stig Morten, Brekke Hege Kristin, Haugen Oddbjørn, Farstad Marit, Husby Paul
Department of Anesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway.
Resuscitation. 2008 Nov;79(2):292-300. doi: 10.1016/j.resuscitation.2008.06.008. Epub 2008 Jul 24.
To describe how surface cooling compared with core cooling influences fluid and protein distribution, vascular capacity and hemodynamic variables.
14 anesthetized piglets were, following 60 min normothermic stabilization, randomly cooled by surface cooling (ice-sludge) (n=7) or core cooling (endovascular cooling) (n=7) to about 28 degrees C. Fluid balance, hemodynamic variables, colloid osmotic pressures (plasma/interstitial fluid), hematocrit, serum-albumin and -protein concentrations, intracranial pressure (ICP) and cerebral metabolic markers of ischemia were measured. Fluid shifts and changes in albumin and protein masses were calculated. At the end total tissue water content was assessed and compared with a normothermic control group.
Both cooling modes induced an increase in fluid extravasation rate from 33.9 (31.9) and 27.8 (28.0) to 109.0 (16.5) (P=0.006) and 95.6 (29.1) ml/kg/min x 10(-3) (P=0.024) in the surface-cooled and core-cooled groups, respectively. Albumin extravasation was reflected by a significant drop in the albumin mass from 148.8 (11.7) to 111.4 (10.3) (P=0.000) and from 163.4 (27.8) to 136.8 (19.0) g/kg x 10(-2) (P=0.001) in the surface-cooled and core-cooled animals, respectively. Similar findings were obtained concerning serum-protein masses. The total tissue water content increased in most organs including brain in both study groups compared with a control. ICP and cerebral metabolic markers remained normal in both groups.
Rapid lowering of body core temperature results in extravasation of water and proteins. The amount of extravated fluid and proteins is similar either cooling is a result of surface cooling or core cooling. Cold-induced fluid extravasation is associated with edema in most tissues including brain.
描述体表降温与核心降温相比如何影响液体和蛋白质分布、血管容量及血流动力学变量。
14只麻醉仔猪在60分钟常温稳定后，随机分为体表降温组（冰泥降温）（n = 7）和核心降温组（血管内降温）（n = 7），冷却至约28℃。测量液体平衡、血流动力学变量、胶体渗透压（血浆/组织间液）、血细胞比容、血清白蛋白和蛋白质浓度、颅内压（ICP）以及缺血性脑代谢标志物。计算液体转移以及白蛋白和蛋白质质量的变化。最后评估总组织含水量，并与常温对照组进行比较。
两种降温方式均导致液体外渗率增加，体表降温组从33.9（31.9）增加到109.0（16.5）ml/kg/min×10⁻³（P = 0.006），核心降温组从27.8（28.0）增加到95.6（29.1）ml/kg/min×10⁻³（P = 0.024）。体表降温组和核心降温组动物的白蛋白质量分别从148.8（11.7）显著降至111.4（10.3）（P = 0.000）和从163.4（27.8）降至136.8（19.0）g/kg×10⁻²（P = 0.001），反映了白蛋白外渗情况。血清蛋白质质量也有类似发现。与对照组相比，两个研究组的大多数器官（包括脑）的总组织含水量均增加。两组的ICP和脑代谢标志物均保持正常。
快速降低身体核心温度会导致水和蛋白质外渗。无论降温是通过体表降温还是核心降温，外渗的液体和蛋白质数量相似。冷诱导的液体外渗与包括脑在内的大多数组织中的水肿有关。
