Marelli D, Paul A, Samson R, Edgell D, Angood P, Chiu R C
Department of Surgery, Montreal General Hospital/McGill University, Quebec Canada.
J Thorac Cardiovasc Surg. 1989 Nov;98(5 Pt 1):751-6.
Colloid solution is commonly used to increase the oncotic pressures of priming solutions used in the cardiopulmonary bypass circuit. To study the effectiveness of this practice, we prospectively randomized 100 adult patients undergoing cardiac operations to receive Ringer's lactate solution plus 50 gm of albumin (group A) or Ringer's lactate solution alone (group B) as the prime solution for the bypass circuit. Personnel involved in the management of these patients were blinded concerning the group to which the patients had been randomized. Forty clinical parameters related to perioperative fluid balance, cardiopulmonary function, and renal function were studied. Although group B received a larger volume of crystalloid solution intraoperatively (p less than 0.05), had a lower mean cardiac filling pressure (p less than 0.05), and had a higher hematocrit value (p less than 0.05) in the immediate postoperative period, all mean values for both groups were within the normal range. There were no differences between the two groups with regard to postoperative clinical parameters of cardiopulmonary and renal function, nor was outcome affected by the addition of albumin to the prime solution. We conclude that there is no clinically detectable advantage for the practice of adding 50 gm of albumin to the priming solution of bypass circuits in adults undergoing cardiac operations. Routinely supplementing the bypass prime solution with albumin adds significant cost, estimated to be approximately $10,000 per 100 cases, without demonstrable clinical benefits. Whether this practice can be of value in selected cases needs to be further studied.
胶体溶液常用于增加心肺转流回路中预充液的胶体渗透压。为研究这种做法的有效性，我们前瞻性地将100例接受心脏手术的成年患者随机分组，A组接受乳酸林格氏液加50克白蛋白作为转流回路的预充液，B组仅接受乳酸林格氏液作为预充液。参与这些患者管理的人员对患者的随机分组情况不知情。研究了40项与围手术期液体平衡、心肺功能和肾功能相关的临床参数。尽管B组术中接受了更大体积的晶体液（p<0.05），术后即刻平均心脏充盈压较低（p<0.05），血细胞比容值较高（p<0.05），但两组的所有平均值均在正常范围内。两组在心肺和肾功能的术后临床参数方面没有差异，向预充液中添加白蛋白也未影响预后。我们得出结论，对于接受心脏手术的成年患者，在心肺转流回路的预充液中添加50克白蛋白的做法没有临床可检测到的优势。常规向预充液中补充白蛋白会增加显著成本，估计每100例约为10,000美元，且无明显临床益处。这种做法在特定病例中是否有价值需要进一步研究。
