Choi Byung Moon, Karm Myung Hwan, Jung Kyeo Woon, Yeo Young Goo, Choi Kyu Taek
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea.
The College of Engineering Hanyang University, Seoul, Korea.
Korean J Anesthesiol. 2015 Apr;68(2):128-35. doi: 10.4097/kjae.2015.68.2.128. Epub 2015 Mar 30.
In a previous study, fluid kinetic models were applied to describe the volume expansion of the fluid space by administration of crystalloid and colloid solutions. However, validation of the models were not performed, it is necessary to evaluate the predictive performance of these models in another population.
Ninety five consenting patients undergoing elective spinal surgery under general anesthesia were enrolled in this study. These patients were randomly assigned to three fluid groups i.e. Hartmann's solution (H group, n = 28), Voluven® (V group, n = 34), and Hextend® (X group, n = 33). After completion of their preparation for surgery, the patients received a loading and maintenance volume of each fluid predetermined by nomograms based on fluid pharmacokinetic models during the 60-minute use of an infusion pump. Arterial samples were obtained at preset intervals of 0, 10, 20, and 30 min after fluid administration. The predictive performances of the fluid kinetic modes were evaluated using the fractional change of arterial hemoglobin. The relationship between blood-volume dilution and target dilution of body fluid space was also evaluated using regression analysis.
A total of 194 hemoglobin measurements were used. The bias and inaccuracy of these models were -2.69 and 35.62 for the H group, -1.53 and 43.21 for the V group, and 9.05 and 41.82 for the X group, respectively. The blood-volume dilution and target dilution of body-fluid space showed a significant linear relationship in each group (P < 0.05).
Based on the inaccuracy of predictive performance, the fluid-kinetic model for Hartmann's solution showed better performance than the other models.
在先前的一项研究中，流体动力学模型被用于描述通过输注晶体液和胶体液引起的液体空间容积扩张。然而，这些模型尚未得到验证，有必要在另一人群中评估这些模型的预测性能。
本研究纳入了95例在全身麻醉下接受择期脊柱手术且表示同意的患者。这些患者被随机分为三组液体组，即哈特曼氏溶液组（H组，n = 28）、万汶组（V组，n = 34）和贺斯组（X组，n = 33）。在完成手术准备后，患者在使用输液泵的60分钟内接受根据基于流体药代动力学模型的列线图预先确定的每种液体的负荷量和维持量。在给予液体后的0、10、20和30分钟的预设时间间隔采集动脉血样。使用动脉血红蛋白的分数变化评估流体动力学模型的预测性能。还使用回归分析评估血容量稀释与体液空间目标稀释之间的关系。
总共进行了194次血红蛋白测量。这些模型的偏差和不准确度在H组分别为-2.69和35.62，在V组分别为-1.53和43.21，在X组分别为9.05和41.82。每组血容量稀释与体液空间目标稀释均呈显著线性关系（P < 0.05）。
基于预测性能的不准确度，哈特曼氏溶液的流体动力学模型表现优于其他模型。
