During cardiopulmonary bypass (CPB) an adequate reservoir volume is maintained by the addition of crystalloid, colloid or packed cells to the reservoir. This volume contributes to the overall perioperative positive fluid balance. We studied the effect of the preoperative addition of either 75 g albumin, or 50 g mannitol followed by 50 g at commencement of rewarming or both of the above to a bypass circuit prime of lactated Ringer's solution (LR) on intraoperative fluid balance, postoperative indices of oxygenation and time to extubation. The study was a prospective, randomized, single-blinded controlled trial of 103 patients undergoing cardiac surgery requiring CPB. There was a large and highly significant reduction in volume of fluid added to the reservoir during CPB (2137 +/- 1499 ml versus 144 +/- 230 ml), the fluid balance during bypass, including prime volume (3236 +/- 650 ml versus 5876 +/- 1465 ml), and perioperative fluid balance (4470 +/- 936 ml versus 7023 +/- 1760 ml) in the group receiving both mannitol and albumin in the pump prime compared with the group receiving only lactated Ringer's solution. There were no differences between the groups with respect to both measured indices of oxygenation measured on return to ICU (alveolar-arterial oxygen tension difference (DA-aO2) or arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2), or time from ICU admission to extubation.

译文

在体外循环 (CPB) 期间,通过向储存器中添加晶体,胶体或填充细胞来维持足够的储存器体积。该体积有助于整个围手术期的积极液体平衡。我们研究了术前添加75g白蛋白或50g甘露醇,然后在重新加温开始时添加50g或以上两者对乳酸林格氏液 (LR) 旁路回路的影响,对术中液体平衡,术后氧合指数和拔管时间。该研究是一项前瞻性,随机,单盲对照试验,对103名需要CPB进行心脏手术的患者进行了试验。在CPB期间 (2137 +/-1499毫升对144 +/-230毫升),在旁路期间的流体平衡,包括主要体积 (3236 +/-650毫升对5876 +/-1465毫升),添加到储层的流体体积有很大且非常显著的减少,与仅接受乳酸林格氏液的组相比,在泵中同时接受甘露醇和白蛋白的组的围手术期液体平衡 (4470/-936毫升对7023/-1760毫升)。两组之间在返回ICU时测量的氧合指标 (肺泡动脉氧张力差异 (DA-aO2) 或动脉血氧张力与吸入氧分数之比 (PaO2/FiO2) 或从ICU入院到拔管的时间) 方面没有差异。

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