Infusionstherapie (Basel, Switzerland)最新文献

Data of parenteral sodium dosage in healthy children recommended by several textbooks vary by the factor 4. Therefore, we studied the effect of low and high i.v. dosage administered in 5-5.5% glucose for 12 hrs to probands without renal disease. Group 1: n = 13; Na 2.2 +/- 0.4, K 1.7 +/- 0.2, Cl 4.2 +/- 0.6 mmol/kg/d, individually composed solutions. Group 2: n = 17; Na 5.1 +/- 1.3, K 1.6 +/- 0.5, Cl 5.8 +/- 1.5, acetate 2.4 +/- 0.6 mmol/kg/d; Ca, Mg, malate, glycerol phosphate below 0.3 mmol/kg/d; commercial ready-for-use mixtures. Compared to the control period, the excretion of Na into the urine was unchanged in group 1 during the infusion but significantly lowered in group 2. Regression analysis reveals that infusion of 2.7 mmol Na/kg/d would have given a balanced sodium balance. The real parenteral requirement, however, may be below this value, as the excretion of Na during the control period indicates that the probands in both groups were overloaded with Na before the beginning of the study. During infusion, the renal clearance of creatinine was unchanged in group 1 but significantly lowered in group 2 (131 +/- 58 vs. 94 +/- 38 ml/min/1.73 m2; p less than 0.01). We would like to recommend to elucidate the mechanism and the clinical significance of this effect before using the commercial solution in clinical routine.

A newly developed filter-system (PL 100) for the removal of leukocytes from platelet concentrates was tested. It removes contaminating leukocytes by 99.7 +/- 0.6%. The platelet loss was calculated as 25.7 +/- 9.5%. The filtration process does not influence the filtered platelets; plasma-electrolytes, LDH-concentrations, platelet aggregation curves and serotonin-release remain constant. In addition, platelet ultrastructure is not influenced by the filtration. In spite of the high platelet loss, the tested filter-system seems to be a suitable alternative to the conventional methods for the removal of contaminating leukocytes from platelet concentrates.

A group of 24 patients which underwent extensive abdominal surgery (gastrectomy and esophagus resection) were fed with a chemically defined diet by way of a needle catheter jejunostomy starting on day five postoperatively. On the fourth postoperative day the jejunocaecal transit time was measured by hydrogen breath test with a median of 97.5 min. Under enteral nutrition, hydrogen exhalation showed a significant rise in all patients. The 8 patients who developed diarrhea (33%) had significantly elevated hydrogen exhalation in relationship to the patients with no diarrhea. 6-12 h before diarrhea, patients had a significant increase in their hydrogen exhalation in correlation to the beginning of carbohydrate malabsorption. Therefore, the hydrogen breath test is a simple, non-invasive method to evaluate carbohydrate malabsorption and the risk of developing diarrhea under enteral nutrition.

Anaesthesiology and transfusion medicine are presented as two specialties in medicine which have many common interests and mutual bonds. They both are young developments with similar historical stages during the last centuries and fulminant final progresses within the last decades. In a state of the art review transfusion medicine is described as a new specialty whose complexity, its nowadays accepted facets, the goals and topics are clearly understood. The anaesthesiologist as the clinician with the greatest proximity to blood transfusion should know about transfusion medicine not only theoretical basic science, but also practical clinical work. It is necessary for anaesthetists to know about immunology, haemoglobin levels, blood coagulation and the haemodynamics of circulation, some of these facets being already well known to him from everyday work in the O.R. and at the ICU. The anaesthetist must furthermore be familiar with bed side pretransfusion testing, autologous blood transfusion, the indications for an appropriate use of the different blood components and the danger of adverse effects of blood transfusion. A clear and safe use of blood during surgery and in the intensive care medicine must be the final goal for anaesthesiologists wanting to fulfill their tasks properly.

O2-uptake was measured continuously in 18 polytraumatized and 21 long-term ventilated patients. All patients were on assisted ventilation with sufficient sedation and analgesia. O2-uptake was measured every minute, the values were recorded over 24 h and the mean O2-uptake/min was calculated. At the same time, the O2-uptake of the last 15 min of every hour was measured separately (e.g. 7.45-8.00, 8.45-9.00, etc.). The mean O2-uptake/min measured continuously was compared and correlated with the mean O2-uptake per day, calculated on the basis of each of the short-term measurements. There were only slight differences between the mean values of the two procedures: In the group of long-term ventilated patients the mean O2-uptake was found to be 364 ml/min in continuous measurements and 363 ml/min in short-term measurements. This O2-uptake corresponded to an energy expenditure of 2360 kcal/day. The mean correlation coefficient was 0.89 (range: 0.79-0.96). If O2-uptake was measured over 2 periods of 15 min each, e.g. in the late morning and in the afternoon, the mean correlation coefficient improved to 0.94 and the standard deviation was reduced. Comparable results were obtained in the group of polytraumatized patients. This study shows that under certain preconditions short-term measurements of O2-uptake of 2 x 15 min allow sufficiently reliable predictions of the daily O2-uptake and energy expenditure in severely traumatized or critically ill patients.

Present knowledge on the possible cause of the tryptophan-induced eosinophilia-myalgia syndrome is discussed on the basis of a literature survey. The initially favored hypothesis of metabolites of a deranged tryptophan metabolism in some persons as cause of the syndrome has no plausibility for several reasons discussed in this paper. In the meantime trace backs of implicated tryptophan lots have led to one manufacturer who has changed his production procedure. The implicated lots contain a variety of impurities detectable by HPLC. Whether these impurities are the immediate cause of the syndrome or just markers remains to be established. An animal model suitable to clarify this question has recently been developed. Taking all these measures to identify and eliminate suspicious lots, there is no reason to withhold live saving artificial nutrition with tryptophan-containing preparations.

20 patients scheduled for total hip replacement were given 1,000 ml of a new preparation of 10% hydroxyethylstarch (HES) (MW 270,000: 0.5) preoperatively. They were compared to a group of 20 patients who received 1,000 ml of 3.5% plasma protein solution (PPS). HES caused a more pronounced hemodilution than PPS. With HES, central venous pressure (CVP) rose significantly higher than with PPS. PTT was significantly prolonged in the HES but not in the PPS group. TT was significantly reduced by HES in comparison to PPS. PT (Quick-value %) and fibrinogen levels showed no difference in both groups. Blood loss and transfusion volume were comparable to HES and PPS until 24 h after the operation. One patient showed generalised flush after HES. This HES preparation is a colloid with volume-expanding properties and appears to be without clinically apparent effects on coagulation (up to a volume of 11).

A requirement-adapted peripheral-venous parenteral nutrition was developed by exchanging the conventional carbohydrates like glucose, etc., for disaccharide maltose in combination with a fat emulsion (650 mosm/l; 2,000 kcal). In a clinical randomised study, we compared this nutrition regimen with a common requirement-adapted parenteral nutrition regimen, which was applicated by central-venous catheter (2,000 mosm/l; 2,000 kcal). All results, including the results of tracer-investigations with the strable isotope 13C-leucine, showed no metabolic difference between these two nutrition regimens.