交体溶质平衡作为神经损伤成人血容量测量指标的有效性。

Validity of exchangeable solute balance as a measure of blood volume in neurologically injured adults.

机构信息

Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359810, Seattle, WA, 98104, USA,

出版信息

Neurocrit Care. 2014 Aug;21(1):102-7. doi: 10.1007/s12028-013-9915-1.

DOI:10.1007/s12028-013-9915-1

PMID:24057812

Abstract

BACKGROUND

Daily weight (DW) and examination of fluid balances (FB) are commonly used in assessments of extracellular fluid (ECF) and circulating blood volume (BV). We hypothesized that a calculated total body exchangeable solute, the main determinant of the ECF, would have high agreement and correlation with actual BV.

METHODS

The University of Washington IRB approved the study. We included a sample of consecutive adult patients in whom a BV was measured, while in the neuroscience intensive care units of a large academic medical center. BV was measured as part of routine care using iodinated (131)I albumin injection and the BVA-100 (Daxor Corp, New York, NY, USA). Total body exchangeable solute was estimated at the time of BV measurement by multiplying the calculated total body water by the sum of the sodium plus potassium and chloride measured in plasma. The correlation between the change in DW, FB (adjusted for insensible fluid loss), exchangeable solute, and BV was performed using linear regression with adjustment for number of days between admit and BV measurement, and capillary leak. Errors were computed using robust variance estimation.

RESULTS

55 patients had BV tests available, and 43 of them had subarachnoid hemorrhage. Total body exchangeable solute strongly correlated with BV (r = 0.75, 95% CI 0.63-0.84, p < 0.01 for Na(+)/K(+), and r = 0.71, 95% CI 0.58-0.81, p < 0.01 for Cl(-)). DW (r = 0.21) and FB (r = 0.11) were not correlated with BV.

CONCLUSIONS

Total body exchangeable solute appears to be a valid and reliable measure of BV and can be calculated using information readily available at the bedside. The value of having this information automatically calculated and available at the bedside should be explored.

摘要

背景

日常体重（DW）和液体平衡检查（FB）常用于评估细胞外液（ECF）和循环血容量（BV）。我们假设，作为 ECF 主要决定因素的全身可交换溶质的计算值与实际 BV 具有高度一致性和相关性。

方法

华盛顿大学 IRB 批准了该研究。我们纳入了一个在大型学术医疗中心神经重症监护病房中进行 BV 测量的连续成年患者样本。BV 作为常规护理的一部分进行测量，使用放射性碘（131）I 白蛋白注射和 BVA-100（Daxor Corp，纽约，NY，USA）进行测量。全身可交换溶质是在 BV 测量时通过将计算的全身水量乘以血浆中测量的钠加钾和氯的总和来估计的。使用线性回归，通过调整住院至 BV 测量的天数和毛细血管漏，对 DW、FB（调整不显性液体丢失）、可交换溶质和 BV 的变化之间的相关性进行了分析。使用稳健方差估计计算误差。

结果

55 名患者有 BV 测试结果，其中 43 名患者患有蛛网膜下腔出血。全身可交换溶质与 BV 呈强相关性（r = 0.75，95%CI 0.63-0.84，Na(+)/K(+)为 p < 0.01；r = 0.71，95%CI 0.58-0.81，Cl(-)为 p < 0.01）。DW（r = 0.21）和 FB（r = 0.11）与 BV 无相关性。