Wahba A, Sendtner E, Birnbaum D E
Department of Cardiac, Thoracic, and Vascular Surgery, University of Regensburg, Germany.
Thorac Cardiovasc Surg. 1996 Aug;44(4):178-82. doi: 10.1055/s-2007-1012012.
Several colloid preparations are available for fluid resuscitation following heart surgery. We conducted a randomized prospective trial to compare a polygeline infusion versus human albumin with respect to hemodynamic and pulmonary function. 20 patients were randomly assigned to receive either Haemaccel or human albumin using a standardized protocol for the first 8 hours following heart surgery. The double-indicator dilution method was used to measure total blood volume index (TBVI), intrathoracic blood volume index (ITBVI) and extravascular lung water index (EVLWI) three times during the study period. Pulmonary shunt fraction, time on ventilator, and chest tube drainage were measured as well. Hemodynamic stability was achieved in both groups throughout the study period, as judged from mean arterial pressure, pulmonary capillary wedge pressure, and cardiac index. ITBV and TBVI were higher in the albumin group, although only significant at 4 hours for TBVI. There was no significant difference in EVLWI, pulmonary shunt fraction, and time on mechanical ventilation. Likewise, chest tube drainage was not significantly different in both groups. Haemaccel is effective in maintaining hemodynamic stability following heart surgery without ill effects of lung function or chest tube drainage. Treatment costs are substantially lower compared to human albumin.
心脏手术后有几种胶体制剂可用于液体复苏。我们进行了一项随机前瞻性试验，比较聚明胶肽输注与人血白蛋白在血流动力学和肺功能方面的差异。20名患者在心脏手术后的前8小时，按照标准化方案被随机分配接受海脉素或人血白蛋白治疗。在研究期间，采用双指示剂稀释法三次测量全血容量指数（TBVI）、胸腔内血容量指数（ITBVI）和血管外肺水指数（EVLWI）。同时也测量了肺分流分数、呼吸机使用时间和胸管引流量。根据平均动脉压、肺毛细血管楔压和心脏指数判断，两组在整个研究期间均实现了血流动力学稳定。白蛋白组的ITBV和TBVI较高，不过TBVI仅在4小时时具有显著差异。EVLWI、肺分流分数和机械通气时间方面无显著差异。同样，两组的胸管引流量也无显著差异。海脉素在心脏手术后维持血流动力学稳定方面有效，且对肺功能或胸管引流无不良影响。与人体白蛋白相比，治疗成本要低得多。
