小儿心脏手术期间容量监测在输液治疗中的意义。
The significance of oncometry for infusion therapy during pediatric heart surgery.
作者信息
Bartels C, Hadzik B, Abel M, Roth B, Diefenbach C, De Vivie R
机构信息
Department of Cardiovascular Surgery, University of Cologne, Medical Center, Germany.
出版信息
J Cardiovasc Surg (Torino). 1998 Feb;39(1):87-93.
BACKGROUND
The colloid osmotic pressure (COP) is not routinely assessed during pediatric heart surgery. Two cases of unrecognized hyperoncotic states associated with renal failure have been observed after pediatric heart surgery. We studied the hypothesis that the COP cannot be estimated from the total plasma protein (TPP) or albumin level.
METHODS
The course of COP and its correlation to the TPP and albumin level were investigated in 25 children undergoing elective heart surgery. Infusion therapy was performed solely on the basis of clinical parameters and TPP/albumin levels. COP values were determined in a blinded fashion at the end of the study.
RESULTS
No correlation between TPP/albumin and the COP could be determined preoperatively. On arrival at the ICU correlation was strong. A weak correlation was observed at 24 hours and 48 hours after surgery. However, the observed wide range of the confidential bands indicates that the COP cannot be estimated correctly, neither from the TPP, nor from the albumin level. Due to colloidal oversubstitution COP was significantly increased compared to preoperative level at 48 hrs following surgery.
CONCLUSIONS
As estimation of COP from TPP or albumin level is inaccurate, oncometry should be performed during pediatric heart surgery.
背景
小儿心脏手术期间通常不常规评估胶体渗透压（COP）。小儿心脏手术后已观察到两例与肾衰竭相关的未被识别的高渗状态病例。我们研究了COP无法从总血浆蛋白（TPP）或白蛋白水平进行估算的假设。
方法
对25例接受择期心脏手术的儿童研究了COP的变化过程及其与TPP和白蛋白水平的相关性。仅根据临床参数和TPP/白蛋白水平进行输液治疗。在研究结束时以盲法测定COP值。
结果
术前无法确定TPP/白蛋白与COP之间的相关性。到达重症监护病房时相关性很强。术后24小时和48小时观察到弱相关性。然而，观察到的置信区间范围很宽，这表明COP既不能从TPP也不能从白蛋白水平正确估算。由于胶体过度替代，术后48小时COP与术前水平相比显著升高。
结论
由于从TPP或白蛋白水平估算COP不准确，小儿心脏手术期间应进行渗透压测定。
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