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[围手术期肾小球滤过率和细胞外液量的测定方法]

[Method of determining glomerular filtration rate and extracellular fluid volume in the perioperative phase].

作者信息

Kletter K, Lackner F, Zimpfer M

出版信息

Anaesthesist. 1985 Nov;34(11):600-6.

PMID:3937460
Abstract

In the course of an investigation concerning the renal response in abdominal surgery, we paid special attention to the precision of determination of the glomerular filtration rate (GFR) and extracellular fluid volume (ECF). The influence of the applied mathematical model on calculation using slope techniques was examined. ECF and GFR were measured by single injection of the radioactive tracer 51Cr-EDTA; plasma samples were taken during the first 4 h postinjection. The results were computed according to the compartmental and noncompartmental model. The correlation between two-compartmental and noncompartmental GFR and ECF values was highly significant. However, values calculated from two-compartmental model were significant lower (p less than 0.01) and differences up to 20% were observed. Calculating ECF by the most widely used approximative method (assuming an early equilibrium between the extra- and intravascular part of ECF) yields incredible high values and correlation to other methods was poor. Based on our data, we conclude that GFR and ECF values obtained by compartmental analysis depend on flow rates between the theoretical compartments. Also the use of two or three exponential components for the plasma curve in the course of noncompartmental analysis (as done by most authors) is not any better than compared conventional compartmental analysis. Noncompartmental analysis should be preferred especially when small changes in ECF and GFR are observed, as it is the more accurate.

摘要

在一项关于腹部手术中肾脏反应的研究过程中,我们特别关注肾小球滤过率(GFR)和细胞外液量(ECF)测定的精确性。研究了所应用的数学模型对斜率技术计算的影响。通过单次注射放射性示踪剂51Cr - EDTA来测量ECF和GFR;在注射后最初4小时内采集血浆样本。根据房室模型和非房室模型计算结果。两房室模型和非房室模型的GFR及ECF值之间的相关性非常显著。然而,由两房室模型计算得出的值显著更低(p小于0.01),且观察到差异高达20%。采用最广泛使用的近似方法(假设ECF血管外和血管内部分之间早期达到平衡)计算ECF会得出高得离谱的值,并且与其他方法的相关性较差。基于我们的数据,我们得出结论,通过房室分析获得的GFR和ECF值取决于理论房室之间的流速。同样,在非房室分析过程中(大多数作者所做的那样)对血浆曲线使用两个或三个指数成分并不比传统房室分析更好。非房室分析应更受青睐,特别是当观察到ECF和GFR有微小变化时,因为它更准确。

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