Sade R M, Stroud M R, Crawford F A, Kratz J M, Dearing J P, Bartles D M
J Thorac Cardiovasc Surg. 1985 May;89(5):713-22.
The ideal priming fluid for cardiopulmonary bypass is not known. We designed a study to determine whether there are important differences in the clinical effects of hydroxyethyl starch versus albumin when used in priming fluid, and in the clinical effects of colloid versus crystalloid priming fluid. We prospectively randomized 83 adult patients undergoing coronary artery bypass or valve replacement. All patients were managed by standardized protocol, and they received one of three priming fluids for bypass: hydroxyethyl starch (HES), 26 patients; albumin (ALB), 28 patients, and lactated Ringer's solution (LRS), 29 patients. The groups were stratified by body weight and type of operation. We measured 41 variables relating to operative time factors, fluid balance, bleeding, and organ function (renal, cardiac, and pulmonary) at several time intervals. The LRS group had a significantly lower colloid osmotic pressure than the other two groups, and the HES group had a substantially higher blood viscosity. Although the prothrombin time was significantly lower in the LRS group (p less than 0.05), the differences were very small and not clinically important. The platelet count in the HES group was significantly lower than in the other two groups immediately after bypass, but it was not different by the time the patients left the operating room. There were no differences among the groups in chest tube drainage, blood bank usage, or fluid balance. Postoperatively, the pulmonary shunt fraction was significantly greater in the LRS group. Body weight increased more in the LRS than in the HES and ALB groups (p = 0.01). No adverse reaction to the prime solutions was noted. The differences between the HES and ALB groups--prothrombin time, platelet count, and blood viscosity--had no apparent clinical effects; thus, the two may be considered clinically equivalent. The greater somatic and pulmonary fluid accumulation in the LRS group suggests that colloid is preferable to crystalloid in priming fluid.
体外循环的理想预充液尚不清楚。我们设计了一项研究，以确定羟乙基淀粉与白蛋白用于预充液时在临床效果上是否存在重要差异，以及胶体预充液与晶体预充液在临床效果上的差异。我们对83例接受冠状动脉搭桥术或瓣膜置换术的成年患者进行了前瞻性随机分组。所有患者均按照标准化方案进行管理，并接受三种体外循环预充液之一：羟乙基淀粉（HES），26例患者；白蛋白（ALB），28例患者；乳酸林格氏液（LRS），29例患者。根据体重和手术类型对各小组进行分层。我们在几个时间间隔测量了41个与手术时间因素、液体平衡、出血和器官功能（肾脏、心脏和肺）相关的变量。LRS组的胶体渗透压明显低于其他两组，而HES组的血液粘度明显更高。尽管LRS组的凝血酶原时间明显更低（p<0.05），但差异非常小且无临床意义。体外循环后立即测量发现，HES组的血小板计数明显低于其他两组，但在患者离开手术室时并无差异。各小组在胸管引流量、血库使用量或液体平衡方面没有差异。术后，LRS组的肺分流分数明显更高。LRS组体重增加比HES组和ALB组更多（p = 0.01）。未观察到对预充液的不良反应。HES组和ALB组之间在凝血酶原时间、血小板计数和血液粘度方面的差异没有明显的临床影响；因此，两者在临床上可视为等效。LRS组更大的体腔和肺内液体蓄积表明，预充液中胶体优于晶体。
