Infusionstherapie (Basel, Switzerland)最新文献

The computer program PEDINFUS permits the fast and simple definition of the individual nutrient amounts and infusion volumes in accordance with age, weight and possible metabolic complications for children up to 18 years. All components needed for total parenteral nutrition are taken into account. The conditions necessary for the optimal satisfaction of the individual needs of each patient by means of combined solutions have thus been created.

In an animal model the hemodynamic effects of three infusions of HES during the early stage of a septic syndrome were examined. In nine pigs with a body weight between 29 and 36 kg a septic syndrome was produced by infusion of E. coli endotoxin. 1, 4 and 7 hours after beginning of the endotoxin infusion 250 ml HES 200/0.5 were infused. After the 1st and 3rd infusion an increase of the cardiac output resulted, which was previously lowered, without changes of the CVP. During normal CO the 2nd infusion shows an increase of CVP and MAP. PWP did not change. The reactions of the hemodynamic parameters can be well explained physiologically. A volume supply at a reduced CO increases the latter without influence of the CVP. Normalized CO before the infusion resulted in a CVP-increase. The PWP is not evaluable under the conditions of an elevated pulmonary resistance, as it exists at the septic syndrome.

In an open and uncontrolled trial the frequency and the type of adverse events were registered in patients who received Haemofusin, a hydroxyethyl starch solution, either for volume substitution or haemodilution. A total of 379 patients were investigated. No serious allergic reaction occurred. Headache, fever, rigor, light allergic reactions and nausea were documented in 17 patients. Even if one assumes that these observed concomitant events were caused by the hydroxyethyl starch, Haemofusin proved to be a well-tolerated colloid with a low rate of side effects (4.5%).

In the course of three weeks we examined 42 patients with central indwelling venous catheters for HPN clinically and radiologically for the development of catheter-related complications. Mean patient age was 48 years. In total 47 catheters were implanted. Their mean dwelling time was 37 weeks with the total dwelling time of all catheters amounting to 1773 weeks. In 26%, obstruction of the upper venous systems was the most frequent clinical catheter related complications. However, radiographs showed thrombotic changes on the vessel walls and/or catheter tips in 51%. In the total survey, 66% of the catheters dislocated from the original application site. Overall, 30% of the catheters dislocated into a peripheral vein. The high flexibility of the silicone catheter is probably responsible for this high dislocation rate. Malposition of the catheter represents a major risk in the development of thrombosis and obstruction of the upper venous system. As the catheter is necessary for the patients' survival and the position of the catheter can be corrected after placement we think that routine chest x-rays should be done at least every four weeks.

The use of hypocaloric parenteral nutrition (HPN) is very common in surgical medicine because it allows for a standardized peripheral venous supply of nutrients. HPN causes very little stress to the posttraumatically labile carbohydrate metabolism-this applies to the use of glucose as well as to sugar substitutes: For example, mean glucose concentrations in serum on glucose administration of 2-3 g/kg/day are between 5.5 and 8.4 mmol/l. The mean dose of amino acids of 1.0-1.2 g/kg/day commonly used in HPN leads to a 50-67% improvement in the N-balance compared to an exclusive water/electrolyte supply or the administration of 2 g of carbohydrates per kg and day. Even a high caloric nutritional therapy leads to no significantly improved N-balances on the first posttraumatic days. HPN is recommended after major surgery and severe trauma in order to better estimate the individual metabolic reaction to nutritional supply prior to any consumption-orientated parenteral nutrition. HPN is also important as an adjunct to early-phase enteral nutrition. Its value after moderate surgical interventions is questionable because studies have yet to confirm HPN's clinical efficacy. HPN should not be used after minor surgery or brief periods of fasting. A possible, but as yet uncertified indication for HPN is the longer-term nutrition of very obese patients.

omega-3 fatty acids have recently been placed into the center of interest because of their different effects on fatty acid metabolism as well as on blood coagulation. We do not know if omega-3 fatty acids are essential during childhood, because it was seen that they may have positive effects on the development of the brains of rats and are also present in breast milk. The following report presents the recent state of the scientific knowledge. In fish and grain oil one can find not only omega-6 fatty acids as e.g. arachidonic acid (AA: C 20: 4 omega-6), but also omega-3 fatty acids (e.g.: linolenic acid: C 18:3 omega-3). They are always in a specific ratio to the other: If there are higher concentrations of omega-3 fatty acids, one can find less amounts of omega-6 fatty acids, and vice versa. The most important representatives of the omega-3 fatty acids are metabolites of linolenic acid, such as docosahexaenoic acid: C 22: 6 omega-3 (DHA) and eicosapentaenoic acid: C 20: 5 omega-3 (EPA). The beneficial influence, especially of DHA, on the postnatal development of the retina and brain has been demonstrated in rats and rhesus monkeys. It could be shown that the fatty acid composition of phospholipids of red blood cells conforms to that of the CNS. Nearly the same values could be achieved in infants with both, a diet enriched with fish oil and a feeding with breast milk; this seems to be essential especially for preterm infants, who always have a DHA-deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

The short-period effect of a parenteral application of arginine hydrochloride on the amino acid concentrations was investigated on rats. To enable a judgement to be made on the growth hormone stimulated through arginine, 23 amino acids were determined from the serum of non-hypophysectomized and hypophysectomized animals in each case. A group of non-hypophysectomized rats was used to determine the normal values. The second group of non-hypophysectomized animals showed reductions in the concentrations of 15 amino acids after arginine infusion in relation to the normal values. In contrast to this the hypophysectomized animals of the third group showed higher values for 14 of the 23 amino acids after infusion with arginine. A direct comparison of the groups of non-hypophysectomized and hypophysectomized rats after infusion with arginine hydrochloride resulted in higher concentrations of 17 amino acids in the group of the hypophysectomized animals. These results suggest that the growth hormone has an influence on the amino acid level within 30 minutes.

The cell separator A 201 was a new platelet pheresis prototype designed to carry out a discontinuous apheresis while platelet-rich plasma (PRP) is sampled continuously. After donation, a platelet concentrate (PC) and a fresh frozen plasma was collected from the PRP by the plasma cell-C device. The PC contained 2.6 +/- 0.7 x 10(11) platelets with a leucocyte contamination of 3.9 +/- 3.9 x 10(8) and an erythrocyte contamination of 3.0 +/- 3.0 x 10(8). The fresh frozen plasma was nearly cell-free. Prior, during and after apheresis we analysed hemolysis and coagulation parameters. There was no evidence for hemolysis. The analysis of the coagulation factors and of the Thrombin-Antithrombin III-complex, however, gave a hint of an activation of coagulation.

302 out of 712 (42%) consecutive polytraumatized ICU patients received ten or more units of stored blood during primary and/or intensive care (1982 to 1987) treatment. 120 of the 197 surviving patients with an average number of transfusions of 23 (10 to 89) units were followed up after a mean interval of 70 (20 to 104) months. Mean duration of continuous post-ICU hospital stay was 17 (2 to 160) weeks, mean number of additional operative procedures was three (0 to 23). Manifest hepatitis had not occurred, all samples were negative for HIV testing. In nine samples (7.5%), anti-HBc-antibodies were positive, while HBs-antigen was negative. Ten patients (8.3%) tested positive for anti-HCV-antibodies (one combined with positive anti-HBc). The rate of serologically positive samples increased with the number of blood units given, duration of overall hospital stay and/or number of secondary surgery; all these findings failed to prove statistically significant. The rate of seropositivity for anti-HBc-antibodies corresponded well with the rate found in voluntary donors in FRG. Manifest or chronic hepatitis B was not observed. As to hepatitis C, the incidence of seropositivity for anti-HCV was found tenfold higher than in healthy blood donors in FRG. The relevance of this result remains unclear, but might indicate chronic post-transfusional hepatitis with high risk of cirrhosis. Among the patients testing positive for anti-HCV, too, acute manifest hepatitis had not occurred. Recently developed RIBA kits might improve specificity and sensitivity of anti-HCV testing. Thus, the frequency of PTH-C could decrease considerably.