Jenkins I R, Curtis A P
Intensive Care Unit, Fremantle Hospital, Australia.
Perfusion. 1995 Sep;10(5):301-5. doi: 10.1177/026765919501000504.
During cardiopulmonary bypass (CPB) an adequate reservoir volume is maintained by the addition of crystalloid, colloid or packed cells to the reservoir. This volume contributes to the overall perioperative positive fluid balance. We studied the effect of the preoperative addition of either 75 g albumin, or 50 g mannitol followed by 50 g at commencement of rewarming or both of the above to a bypass circuit prime of lactated Ringer's solution (LR) on intraoperative fluid balance, postoperative indices of oxygenation and time to extubation. The study was a prospective, randomized, single-blinded controlled trial of 103 patients undergoing cardiac surgery requiring CPB. There was a large and highly significant reduction in volume of fluid added to the reservoir during CPB (2137 +/- 1499 ml versus 144 +/- 230 ml), the fluid balance during bypass, including prime volume (3236 +/- 650 ml versus 5876 +/- 1465 ml), and perioperative fluid balance (4470 +/- 936 ml versus 7023 +/- 1760 ml) in the group receiving both mannitol and albumin in the pump prime compared with the group receiving only lactated Ringer's solution. There were no differences between the groups with respect to both measured indices of oxygenation measured on return to ICU (alveolar-arterial oxygen tension difference (DA-aO2) or arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2), or time from ICU admission to extubation.
在体外循环（CPB）期间，通过向储血器中添加晶体液、胶体液或浓缩红细胞来维持足够的储血器容量。该容量有助于围手术期总体的正液体平衡。我们研究了在乳酸林格氏液（LR）预充的体外循环管路中，术前添加75 g白蛋白、或50 g甘露醇并在复温开始时再添加50 g甘露醇、或上述两种方法联合使用，对术中液体平衡、术后氧合指标及拔管时间的影响。本研究是一项前瞻性、随机、单盲对照试验，纳入了103例需要CPB的心脏手术患者。与仅接受乳酸林格氏液的组相比，在预充液中同时接受甘露醇和白蛋白的组在CPB期间添加到储血器中的液体量（2137±1499 ml对144±230 ml）、体外循环期间的液体平衡（包括预充量，3236±650 ml对5876±1465 ml）以及围手术期液体平衡（4470±936 ml对7023±1760 ml）均有大幅且极显著的减少。两组在返回重症监护病房（ICU）时测得的氧合指标（肺泡 - 动脉血氧分压差（DA-aO2）或动脉血氧分压与吸入氧分数之比（PaO2/FiO2））或从入住ICU到拔管的时间方面没有差异。
