La Gamma E F, Krauss A, Auld P A
Department of Pediatrics, University at Stony Brook, New York 11794-8111, USA.
Arch Dis Child Fetal Neonatal Ed. 1996 Sep;75(2):F87-93. doi: 10.1136/fn.75.2.f87.
To determine whether there are subclinical deficits in oxygen delivery in ventilated premature neonates.
Ventilated premature neonates weighing less than 1500 g, who were transfused for anaemia or who were given colloids for clotting abnormalities (or oedema), were haemodynamically monitored during the first week of life. Calf muscle surface pH (pH) was measured in conjunction with peripheral limb blood flow by occlusion plethysmography.
Packed red blood cell transfusions corrected a subclinical regional tissue acidosis (low tpH) without affecting arterial pH or limb blood flow. This observation also correlated with an increase in regional oxygen delivery. The data were also suggestive of a pattern of pathological, supply dependent, oxygen delivery and are similar to other observations made in adults with adult respiratory distress syndrome.
Packed red blood cells increase regional oxygen delivery and tissue surface pH. In contrast, colloid infusion provided no substantial cardiovascular or metabolic benefit to these patients and should be avoided when oxygen delivery is at issue and when there may be leaky pulmonary capillaries.
确定机械通气的早产儿是否存在亚临床氧输送不足。
对出生体重小于1500克、因贫血接受输血或因凝血异常（或水肿）接受胶体输注的机械通气早产儿在出生后第一周进行血流动力学监测。通过阻断体积描记法测量小腿肌肉表面pH值（tpH）并结合外周肢体血流情况。
输注浓缩红细胞纠正了亚临床区域性组织酸中毒（低tpH），且未影响动脉pH值或肢体血流。这一观察结果还与区域性氧输送增加相关。数据还提示了一种病理性的、供应依赖性的氧输送模式，与在患有成人呼吸窘迫综合征的成年人中所做的其他观察结果相似。
输注浓缩红细胞可增加区域性氧输送和组织表面pH值。相比之下，胶体输注对这些患者没有显著的心血管或代谢益处，在存在氧输送问题以及可能存在肺毛细血管渗漏时应避免使用。
