Wahba A, Sendtner E, Strotzer M, Wild K, Birnbaum D E
Department of Cardiac, Thoracic, and Vascular Surgery, University of Regensburg, Germany.
Acta Anaesthesiol Scand. 1996 Nov;40(10):1227-33. doi: 10.1111/j.1399-6576.1996.tb05555.x.
Crystalloid and colloid infusion can be used in volume therapy following heart surgery. In this prospective, randomised study we compared Ringer's solution (group R) to Haemaccel (group H) following coronary artery bypass grafting.
A stringent protocol for adjusting the infusion rate was used. Haemodynamic parameters and pulmonary function were evaluated as well as chest tube drainage. The double-indicator dilution method was used to measure total blood volume index (TBVI), intrathoracic blood volume index (ITB-VI) and extravascular lung water index (EVLWI).
Haemodynamic stability was achieved in both groups throughout the study period, as judged from mean arterial pressure, central venous pressure, pulmonary capillary wedge pressure, and cardiac index. However, the total volume infused was significantly higher in group R. TBVI and ITBV were higher in group H, although only significant at 8 h for TBVI. Pulmonary function was similar in both groups. 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.
We conclude that volume therapy with Haemaccel following heart surgery requires less volume and achieves better filling of the circulation compared to Ringer's solution.
晶体液和胶体液输注可用于心脏手术后的容量治疗。在这项前瞻性随机研究中，我们比较了冠状动脉搭桥术后林格氏液（R组）和贺斯（H组）的疗效。
采用严格的方案调整输注速率。评估血流动力学参数、肺功能以及胸腔引流情况。采用双指示剂稀释法测量总血容量指数（TBVI）、胸腔内血容量指数（ITB-VI）和血管外肺水指数（EVLWI）。
根据平均动脉压、中心静脉压、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。然而，R组输注的总体积显著更高。H组的TBVI和ITBV更高，尽管仅TBVI在8小时时有显著差异。两组的肺功能相似。EVLWI、肺分流分数和机械通气时间无显著差异。同样，两组的胸腔引流量也无显著差异。
我们得出结论，与林格氏液相比，心脏手术后用贺斯进行容量治疗所需的液体量更少，且能更好地充盈循环系统。
