Myers G A, Conhaim R L, Rosenfeld D J, Harms B A
Department of Surgery, University of Wisconsin Hospital and Clinics, Madison 53792.
Surgery. 1995 Mar;117(3):340-9. doi: 10.1016/s0039-6060(05)80211-9.
Hetastarch and pentafraction are high molecular weight starch solutions designed to augment plasma oncotic pressure. Although clinical utilization of hetastarch has been limited by reported coagulation abnormalities, pentafraction is a newer derivative that appears to have few adverse hemostatic effects. We examined the ability of pentafraction to modulate lung and soft tissue transvascular fluid filtration under hypoproteinemic conditions compared with hetastarch and Ringer's lactate (LR).
Awake, protein-depleted sheep (n = 19) were prepared with lung and soft tissue lymph fistulas, and comparable infusions of 5% pentafraction (n = 6), 6% hetastarch (n = 6), or LR (n = 7) were administered. Plasma and lymph samples were collected during 24-hour period to determine changes in protein concentrations, plasma-to-lymph oncotic gradients, and lung (QL) and soft tissue (QS) lymph flows.
QL and QS rose nearly twofold after protein depletion alone. LR infusion increased QL and QS to 8.7 +/- 1.7 and 3.1 +/- 0.6 times normoproteinemic baseline, respectively (p < 0.05). In contrast, hetastarch and pentafraction infusion limited the increase in QL to 4.2 +/- 1.1 and 4.0 +/- 0.8 times normoproteinemic baseline, respectively (p < 0.05 versus LR) and did not significantly increase QS. Hetastarch and pentafraction infusions increase plasma oncotic pressure by nearly 6 mm Hg, which significantly widened the plasma-to-lymph oncotic pressure gradients above preinfusion baseline by 4.7 +/- 0.7 and 3.4 +/- 0.4 mm Hg in lung and 4.6 +/- 0.7 and 3.2 +/- 0.4 mm Hg in soft tissue, respectively (p < 0.05).
Both hetastarch and pentafraction limit transvascular fluid filtration under hypoproteinemic conditions by augmenting plasma oncotic pressure and the plasma-to-lymph oncotic pressure gradient. Because of fewer adverse hemostatic effects pentafraction may be an improvement over current therapies in critical care fluid management.
羟乙基淀粉和五聚糖是旨在增加血浆胶体渗透压的高分子量淀粉溶液。尽管羟乙基淀粉的临床应用因报道的凝血异常而受到限制，但五聚糖是一种较新的衍生物，似乎几乎没有不良止血作用。我们研究了与羟乙基淀粉和乳酸林格氏液（LR）相比，五聚糖在低蛋白血症条件下调节肺和软组织跨血管液体滤过的能力。
制备清醒的、蛋白质缺乏的绵羊（n = 19），建立肺和软组织淋巴瘘，并分别输注5%五聚糖（n = 6）、6%羟乙基淀粉（n = 6）或LR（n = 7）。在24小时内采集血浆和淋巴样本，以确定蛋白质浓度、血浆与淋巴胶体渗透压梯度以及肺（QL）和软组织（QS）淋巴流量的变化。
仅蛋白质缺乏后，QL和QS增加了近两倍。输注LR使QL和QS分别增加至正常蛋白血症基线的8.7±1.7倍和3.1±0.6倍（p < 0.05）。相比之下，输注羟乙基淀粉和五聚糖将QL的增加限制在正常蛋白血症基线的4.2±1.1倍和4.0±0.8倍，分别（与LR相比，p < 0.05），并且未显著增加QS。输注羟乙基淀粉和五聚糖使血浆胶体渗透压增加近6 mmHg，这使得肺和软组织中血浆与淋巴胶体渗透压梯度分别比输注前基线显著增宽4.7±0.7 mmHg和3.4±0.4 mmHg以及4.6±0.7 mmHg和3.2±0.4 mmHg（p < 0.05）。
羟乙基淀粉和五聚糖均可通过增加血浆胶体渗透压和血浆与淋巴胶体渗透压梯度来限制低蛋白血症条件下的跨血管液体滤过。由于不良止血作用较少，五聚糖在重症监护液体管理中可能是对当前疗法的一种改进。
