Finsterer U, Kapser S, Reiser-Zimre E, Fottner I
Anaesthesist. 1981 Aug;30(8):383-9.
An increase or a decrease in blood volume caused by adding or subtracting isotonic but protein-free fluid to or from whole blood theoretically will result in disproportionate percentage changes of haematocrit and plasma protein concentration. Percentage changes of plasma protein concentration are larger than those of haematocrit and depend upon the initial haematocrit. It could be demonstrated that the theoretical rules of "isotonic" haemodilution and haemoconcentration do hold in vivo in patients pre- and postoperatively under isotonic volume expansion and furosemide diuresis, respectively. However, during laparotomy with moderate blood loss and infusion of crystalloids only we observed a definite decrease of intravascular protein mass. This seemed to be only partly due to surgical blood loss. We suppose that during laparotomy considerable amounts of intravascular protein, besides those with surgical blood loss, are lost in the area of the wound and into the peritoneal cavity.
理论上，向全血中添加或从全血中减去等渗但无蛋白的液体所导致的血容量增加或减少，将引起血细胞比容和血浆蛋白浓度不成比例的百分比变化。血浆蛋白浓度的百分比变化大于血细胞比容的变化，且取决于初始血细胞比容。可以证明，“等渗”血液稀释和血液浓缩的理论规则分别在等渗容量扩张和速尿利尿的术前和术后患者体内确实成立。然而，在仅输注晶体液且有中度失血的剖腹手术过程中，我们观察到血管内蛋白量明显减少。这似乎仅部分归因于手术失血。我们推测，在剖腹手术期间，除了因手术失血丢失的血管内蛋白外，大量血管内蛋白在伤口部位和腹腔内丢失。
