{"title":"[低分子量羟乙基淀粉(HES 40)与林格液对感染患者骨骼肌氧张力的影响]。","authors":"B Steinberg, E Kochs, H Bause, J Schulte am Esch","doi":"","DOIUrl":null,"url":null,"abstract":"<p><p>Volume expansion for the establishment of normal to slightly hyperdynamic systemic circulation has become part of a standard concept in the treatment of septicemic patients. The goal is an improvement of microcirculation with beneficial effects on tissue oxygen supply. This study investigates the effect of hydroxyethyl starch solution (HES 6%: mean molecular weight = 40,000) versus ringer's solution on tissue oxygen tensions in human skeletal muscle during periods of septicemia in 10 mechanically ventilated ICU-patients. Measurement of tissue oxygen tension was achieved by a polarographic pO2-sensitive flexible probe. After computer assisted analysis pO2-histograms were calculated out of 200 single pO2-values measured consecutively within a time period of 4 min. Infusions of 500 ml ringer's solution or 500 ml HES were given over 60 min in each patient in a randomized order. The second infusion was begun when the pO2-histogram had reproducibly regained control values as measured before treatment. Measurements were made every 30 min after starting the infusion for a total period of 150 min. As a result the median pO2 improved by 24.5% 90 min after the infusion of HES was begun with a simultaneous significant (30 to 150 min; p less than 0.05) drop in hematocrit from 34.3% to 32.4%. In contrast ringer's solution had no significant effect on tissue pO2 whereas the hematocrit was comparable to the HES group in the time period of 30-60 min. In both groups no linear correlation between hematocrit and pO2-tensions could be established. It remains unclear if pO2-tensions during and after HES infusion can be correlated to an improved capillary perfusion. However, as was clearly demonstrated, different types of solutions used for volume expansion may exert different effects on pO2-tissue tension in septic patients.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"24 6","pages":"377-81"},"PeriodicalIF":0.0000,"publicationDate":"1989-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Effects of low molecular weight hydroxyethyl starch (HES 40) in comparison with Ringer solution on oxygen tension in skeletal muscles of infected patients].\",\"authors\":\"B Steinberg, E Kochs, H Bause, J Schulte am Esch\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Volume expansion for the establishment of normal to slightly hyperdynamic systemic circulation has become part of a standard concept in the treatment of septicemic patients. The goal is an improvement of microcirculation with beneficial effects on tissue oxygen supply. This study investigates the effect of hydroxyethyl starch solution (HES 6%: mean molecular weight = 40,000) versus ringer's solution on tissue oxygen tensions in human skeletal muscle during periods of septicemia in 10 mechanically ventilated ICU-patients. Measurement of tissue oxygen tension was achieved by a polarographic pO2-sensitive flexible probe. After computer assisted analysis pO2-histograms were calculated out of 200 single pO2-values measured consecutively within a time period of 4 min. Infusions of 500 ml ringer's solution or 500 ml HES were given over 60 min in each patient in a randomized order. The second infusion was begun when the pO2-histogram had reproducibly regained control values as measured before treatment. Measurements were made every 30 min after starting the infusion for a total period of 150 min. As a result the median pO2 improved by 24.5% 90 min after the infusion of HES was begun with a simultaneous significant (30 to 150 min; p less than 0.05) drop in hematocrit from 34.3% to 32.4%. In contrast ringer's solution had no significant effect on tissue pO2 whereas the hematocrit was comparable to the HES group in the time period of 30-60 min. In both groups no linear correlation between hematocrit and pO2-tensions could be established. It remains unclear if pO2-tensions during and after HES infusion can be correlated to an improved capillary perfusion. However, as was clearly demonstrated, different types of solutions used for volume expansion may exert different effects on pO2-tissue tension in septic patients.</p>\",\"PeriodicalId\":7813,\"journal\":{\"name\":\"Anasthesie, Intensivtherapie, Notfallmedizin\",\"volume\":\"24 6\",\"pages\":\"377-81\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"1989-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anasthesie, Intensivtherapie, Notfallmedizin\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anasthesie, Intensivtherapie, Notfallmedizin","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
为建立正常到轻度高动力的体循环而扩大容量已成为治疗败血症患者的标准概念的一部分。目标是改善微循环,对组织供氧有有益的影响。本研究探讨了10例icu机械通气患者败血症期间羟乙基淀粉溶液(HES 6%:平均分子量= 40000)与林格氏溶液对人体骨骼肌组织氧张力的影响。组织氧张力的测量是通过极谱po2敏感柔性探针实现的。在计算机辅助分析后,在4分钟的时间内连续测量200个单独的po2值,计算出po2直方图。在60分钟内,每个患者按随机顺序输注500 ml林格氏液或500 ml HES。当治疗前测量的po2直方图可重复地恢复控制值时,开始第二次输注。在开始输注后每30分钟测量一次,总时间为150分钟。结果,在开始输注HES后90分钟,中位pO2提高了24.5%,同时显著提高(30至150分钟;P < 0.05),红细胞压积从34.3%下降到32.4%。相比之下,林格液对组织pO2无显著影响,而在30-60 min的时间内,红细胞压积与HES组相当。两组红细胞压积与pO2张力之间均未建立线性相关性。目前尚不清楚HES输注期间和之后的po2 -张力是否与毛细血管灌注改善相关。然而,正如清楚证明的那样,不同类型的体积扩张溶液可能对脓毒症患者的po2组织张力产生不同的影响。
[Effects of low molecular weight hydroxyethyl starch (HES 40) in comparison with Ringer solution on oxygen tension in skeletal muscles of infected patients].
Volume expansion for the establishment of normal to slightly hyperdynamic systemic circulation has become part of a standard concept in the treatment of septicemic patients. The goal is an improvement of microcirculation with beneficial effects on tissue oxygen supply. This study investigates the effect of hydroxyethyl starch solution (HES 6%: mean molecular weight = 40,000) versus ringer's solution on tissue oxygen tensions in human skeletal muscle during periods of septicemia in 10 mechanically ventilated ICU-patients. Measurement of tissue oxygen tension was achieved by a polarographic pO2-sensitive flexible probe. After computer assisted analysis pO2-histograms were calculated out of 200 single pO2-values measured consecutively within a time period of 4 min. Infusions of 500 ml ringer's solution or 500 ml HES were given over 60 min in each patient in a randomized order. The second infusion was begun when the pO2-histogram had reproducibly regained control values as measured before treatment. Measurements were made every 30 min after starting the infusion for a total period of 150 min. As a result the median pO2 improved by 24.5% 90 min after the infusion of HES was begun with a simultaneous significant (30 to 150 min; p less than 0.05) drop in hematocrit from 34.3% to 32.4%. In contrast ringer's solution had no significant effect on tissue pO2 whereas the hematocrit was comparable to the HES group in the time period of 30-60 min. In both groups no linear correlation between hematocrit and pO2-tensions could be established. It remains unclear if pO2-tensions during and after HES infusion can be correlated to an improved capillary perfusion. However, as was clearly demonstrated, different types of solutions used for volume expansion may exert different effects on pO2-tissue tension in septic patients.