Lühr H G, Finsterer U, Meier W, Kapser S, Schiffelholz S, Güntner-Tauschinsky U
Anaesthesist. 1981 Sep;30(9):476-80.
We observed 20 patients undergoing middle-ear surgery under NLA in combination with halothane for controlled hypotension in respect to haematocrit, plasma protein concentration, plasma volume (Evans Blue) and intravascular protein mass during and after anaesthesia and surgery. As surgical bleeding was almost nil and infusion therapy was not necessary, patients behaved as a "closed system". With the start of anaesthesia we found a significant decrease of haematocrit and plasma protein concentration, being complete after 45-60 min, and unchanged thereafter until the end of anaesthesia. Suspicion of an increase in plasma volume could not yet be verified by a measurement of this parameter after 30 min of anaesthesia. Just after termination of anaesthesia we observed a significant increase in haematocrit and plasma protein concentration compared to control values with a downward trend over the next hour. At that point we also measured a decrease in plasma volume by 10% and in plasma protein mass by 6% compared to controls. These findings are interpreted as part of an "arousal reaction" with a temporary disequilibrium between transcapillary filtration rate of water and proteins and back transport of these substances via lymph flow.
我们观察了20例在NLA联合氟烷麻醉下行中耳手术以控制低血压的患者，监测了麻醉及手术期间和术后的血细胞比容、血浆蛋白浓度、血浆容量（伊文思蓝法）和血管内蛋白量。由于手术出血几乎为零且无需输液治疗，患者表现为一个“封闭系统”。麻醉开始后，我们发现血细胞比容和血浆蛋白浓度显著下降，45 - 60分钟后降至最低点，此后直至麻醉结束均无变化。麻醉30分钟后，虽怀疑血浆容量增加，但该参数测量结果尚未证实这一点。麻醉刚结束时，我们观察到血细胞比容和血浆蛋白浓度相较于对照值显著升高，并在接下来的一小时内呈下降趋势。此时我们还测得与对照组相比，血浆容量减少了10%，血浆蛋白量减少了6%。这些发现被解释为“觉醒反应”的一部分，即水和蛋白质的跨毛细血管滤过率与这些物质通过淋巴回流的反向转运之间存在暂时失衡。
