Gallagher J D, Moore R A, Kerns D, Jose A B, Botros S B, Flicker S, Naidech H, Clark D L
Anesth Analg. 1985 Aug;64(8):753-8.
The effect of postoperative fluid management on pulmonary extravascular thermal volume (ETVL) as in index of pulmonary extravascular water after coronary artery bypass grafting was compared, using the thermal-dye technique, among five patients who received 5% albumin (group A), five patients who received 6% hydroxyethyl starch (group H), and five who received lactated Ringer's solution (group C). Intraoperatively, all patients received lactated Ringer's solution intravenously, and the cardiopulmonary bypass (CPB) circuit prime included 5% albumin. No statistically significant changes in ETVL occurred postoperatively in any group, nor did ETVL differ significantly between groups. After CPB, colloid osmotic pressure (COP) significantly decreased and pulmonary artery wedge pressure (WP) and the WP-COP gradient significantly increased in each group, implying an increase in transcapillary fluid flux. Cardiac index changed variably. Pulmonary shunt fraction (Qsp/Qt) did not change in groups A and C but decreased during CPB in group H (from 0.22 +/- 0.03 to 0.16 +/- 0.11). Postoperatively, patients in the three groups received similar volumes of fluids and had similar perioperative weight gains. By the next morning (AM1), COP increased in all groups, returning to levels noted before CPB in group C, and exceeding these levels in groups A and H. Wedge pressure was similar in all three groups on AM1. PaO2 decreased significantly, and alveolar-arterial oxygen partial pressure difference increased significantly in all groups on AM1. In Group H, Qsp/Qt returned to levels observed before CPB by AM1 (0.27 +/- 0.09). We conclude that in patients without postoperative increases in WP, ETVL changes minimally during CPB and is not influenced by the type of fluid administered as the primary volume replacement in the postoperative period.
采用热染料技术，比较了5例接受5%白蛋白治疗的患者（A组）、5例接受6%羟乙基淀粉治疗的患者（H组）和5例接受乳酸林格氏液治疗的患者（C组）在冠状动脉搭桥术后，术后液体管理对作为肺血管外水指标的肺血管外热容量（ETVL）的影响。术中，所有患者均静脉输注乳酸林格氏液，体外循环（CPB）预充液中包含5%白蛋白。术后，任何一组的ETVL均未发生统计学上的显著变化，各组之间的ETVL也无显著差异。CPB后，每组的胶体渗透压（COP）显著降低，肺动脉楔压（WP）和WP-COP梯度显著升高，这意味着跨毛细血管液体通量增加。心脏指数变化不一。A组和C组的肺分流分数（Qsp/Qt）未发生变化，但H组在CPB期间降低（从0.22±0.03降至0.16±0.11）。术后，三组患者接受的液体量相似，围手术期体重增加情况也相似。到第二天上午（AM1），所有组的COP均升高，C组恢复到CPB前的水平，A组和H组超过这些水平。AM1时，三组的楔压相似。所有组在AM1时PaO2显著降低且肺泡-动脉氧分压差显著增加。在H组，到AM1时Qsp/Qt恢复到CPB前观察到的水平（0.27±0.09）。我们得出结论，在术后WP无升高的患者中，CPB期间ETVL变化极小，且不受术后作为主要容量替代的补液类型的影响。
