Scott D A, Hore P J, Cannata J, Masson K, Treagus B, Mullaly J
Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.
Perfusion. 1995 Nov;10(6):415-24. doi: 10.1177/026765919501000605.
This study was designed to assess the effect of different prime solution compositions on a patient's fluid balance, transfusion requirements, renal function and haemodynamic stability over the first 24 hours postbypass. Ninety-three patients presenting for first-time coronary artery bypass graft (CABG) surgery were randomly allocated to receive one of three prime solutions for the CPB pump: albumin (4.6%) + Plasmalyte (Group A, n = 32), polygeline (Hemaccel) + Plasmalyte (Group P, n = 29), or crystalloid (Plasmalyte) alone (Group C, n = 32). Patients, anaesthetists, surgeons and intensive care unit (ICU) staff were all blinded as to the solution type. The groups were demographically and haemodynamically similar. There were no differences between the groups with respect to white cell or platelet counts during the study. There was a significant difference in haemoglobin levels between the groups on weaning from CPB and on arrival in the ICU (Group C > Groups P and A, p < 0.001 for both times). There was no difference in blood transfusion requirements between any of the groups. During CPB, Group C required significantly more crystalloid than the other groups (p < 0.001). Urine output was significantly higher in Group C compared with Groups P and A at all time periods up to and including ICU 12 hours (p < 0.05). The use of frusemide was significantly higher in the ICU in Groups P and A (p < 0.01). There was a net gain of 3132 +/- 412 ml in Group C in 24 hour fluid balance, which was significantly higher than Group A (2166 +/- 223 ml, p = 0.04). Our results show that, in this patient population, there is no advantage in using a colloid-based prime solution over a purely crystalloid solution from a haemotologic or haemodynamic point of view for the first 24 hours after CPB. There appears to be an increase in extracellular fluid (ECF) retention in Group C, but this caused no related problems in the study period. On the other hand, diuretics (frusemide) needed to be given significantly less often in these patients to offset oliguria.
本研究旨在评估不同预充液成分对患者体外循环后最初24小时内液体平衡、输血需求、肾功能及血流动力学稳定性的影响。93例首次行冠状动脉旁路移植术（CABG）的患者被随机分配，接受体外循环泵的三种预充液之一：白蛋白（4.6%）+聚明胶肽（A组，n = 32）、琥珀酰明胶（血代）+聚明胶肽（P组，n = 29）或单纯晶体液（聚明胶肽）（C组，n = 32）。患者、麻醉师、外科医生及重症监护病房（ICU）工作人员均对溶液类型不知情。各组在人口统计学和血流动力学方面相似。研究期间，各组白细胞或血小板计数无差异。在脱离体外循环时及入住ICU时，各组血红蛋白水平存在显著差异（C组高于P组和A组，两个时间点p均< 0.001）。各组输血需求无差异。在体外循环期间，C组所需晶体液显著多于其他组（p < 0.001）。直至ICU 12小时（含）的所有时间段内，C组尿量均显著高于P组和A组（p < 0.05）。在ICU中，P组和A组使用速尿的频率显著更高（p < 0.01）。C组24小时液体平衡净增加3132±412 ml，显著高于A组（2166±223 ml，p = 0.04）。我们的结果表明，在这一患者群体中，从血液学或血流动力学角度来看，体外循环后最初24小时内，使用基于胶体的预充液并不优于单纯晶体液。C组细胞外液（ECF）潴留似乎增加，但在研究期间未引起相关问题。另一方面，这些患者使用利尿剂（速尿）以抵消少尿的频率显著更低。
