Roithmaier A, Arlettaz R, Bauer K, Bucher H U, Krieger M, Duc G, Versmold H T
Department of Paediatrics, University of Munich, Germany.
Eur J Pediatr. 1995 Jan;154(1):53-6. doi: 10.1007/BF01972973.
We tested whether crystalliod solutions could be used instead of colloid solutions for partial exchange transfusions (PET) in polycythaemic neonates because crystalloid solutions are cheap, carry no risk of anaphylactic reactions and can be sterilized. We randomly assigned 20 term neonates with venous haematocrit (Hct) > 0.65 l/l to PET with either a serum preparation (BISEKO) or Ringer solution. Plasma volume (PV) was measured with Evans blue dilution. Blood volume (BV) and red cell mass were calculated from PV and venous Hct. Before PET both serum and Ringer groups had the same Hct (0.69 (0.66-0.76) vs 0.69 (0.66-0.71) l/l; median (range)) and BV (108 (81-116) versus 96 (68-121) ml/kg. During PET an equivalent amount of blood was withdrawn stepwise (19 (14-26) versus 17 (13-25) ml/kg and replaced by either serum or Ringer solution. More of the Ringer solution (median 77%) than of the serum (median 36%) given left the intravascular space within 4 h after PET (P = 0.016); but there was no significant difference in Hct after Ringer-PET compared to serum-PET (median 0.58 vs 0.56 l/l). No infant required repeat PET. Ringer-PET reduced BV from high to normal values (from median 96 to 83 ml/kg; P = 0.005), whereas after serum-PET BV remained high (from median 108 to 98 ml/kg; not significant).
PET with Ringer solution resulted in a haemodilution comparable to PET with serum and a correction of hypervolaemia.
我们测试了晶体溶液是否可用于替代胶体溶液，对患有红细胞增多症的新生儿进行部分换血输血（PET），因为晶体溶液价格便宜，无过敏反应风险且可消毒。我们将20名静脉血细胞比容（Hct）>0.65 l/l的足月儿随机分配接受用血清制剂（BISEKO）或林格溶液进行的PET。用伊文思蓝稀释法测量血浆容量（PV）。根据PV和静脉Hct计算血容量（BV）和红细胞量。在PET前，血清组和林格溶液组的Hct相同（0.69（0.66 - 0.76）对0.69（0.66 - 0.71）l/l；中位数（范围）），BV也相同（108（81 - 116）对96（68 - 121）ml/kg）。在PET期间，逐步抽取等量的血液（19（14 - 26）对17（13 - 25）ml/kg），并用血清或林格溶液替代。PET后4小时内，给予的林格溶液（中位数77%）比血清（中位数36%）更多地离开血管内空间（P = 0.016）；但林格溶液PET后与血清PET后的Hct无显著差异（中位数0.58对0.56 l/l）。没有婴儿需要重复PET。林格溶液PET使BV从高值降至正常范围（从中位数96降至83 ml/kg；P = 0.005），而血清PET后BV仍保持高位（从中位数108降至98 ml/kg；无显著性差异）。
用林格溶液进行PET导致的血液稀释与用血清进行PET相当，并纠正了血容量过多。
