Infusionstherapie (Basel, Switzerland)最新文献

The intention of this study was to examine whether it is possible to induce an acute and long-time hemodilution by a 6% Hydroxyethyl Starch solution (HES 40). This study was investigated in 30 patients with acute cerebral ischemia. Primarily a isovolemic infusion of HES 40 was made in order to reduce the hematocrit nearly 40%. Secondly, a hypervolemic infusion of 1,000 ml/24 h followed during 4 days. Then 500 ml/24 h for the next 6 days, respectively. The neurological staging was estimated by special scores, the rheological effects by changing of values of hematocrit, hemoglobin, plasma viscosity, number of blood cells, concentration of total plasma protein and fibrinogen concentration. It can be stated that HES 40 induced a significant acute and long time decrease of blood parameters (4 weeks later). After this time, the symptoms of cerebral ischemia could not be observed in 54% of cases and were reduced significantly in 31 percent. 2 patients had transitory ischemic attacks and 4 patients died during therapy. These results demonstrate that this new therapy (long time hemodilution with HES 40) is ingenious for patients with acute cerebral ischemia, because HES 40 has lower undesired effects than HES 200.

One type of cellseparators (Haemonetic V 50) was investigated by us concerning the problem whether particles disintegrate during the donation from the tubing set. We did find particles in the range from 18 microns to 180 microns consisting of silicone or aluminum.

In 40 patients, whose expected hemodynamic instability during surgery necessitated invasive monitoring (Swan-Ganz catheter) and arterial pressure monitoring the hemodynamic and oxygen transport parameters in conditions of hypervolemic hemodilution were investigated in randomized tests. After insertion of an arterial catheter (arteria radialis) as well as Swan-Ganz pulmonary arterial catheter via the vena jugularis interna, one of the two volume substitutes selected at random was infused in quantities of 125 ml/5 min and the hemodynamic changes were measured after infusion of 500 ml and finally after a wedge pressure of 18 mmHg was reached. Using either solution, the measurements indicated significant increases in mean arterial pressure as well as in central venous pressure (ZVD) and wedge pressure. The cardiac index, left ventricular stroke work index, and stroke output rose consecutively and pulmonary vascular resistance went down in both test groups. In the case of both volume substitutes, there was an improvement in oxygen availability. The hemoglobin content decreased in both groups, though to different degrees in each group. Although the hydroxyethyl starch group registered a greater improvement in the cardiac index, a bigger decrease in pulmonary vascular resistance, a higher rise in the left ventricular stroke work index and a more significant improvement in stroke output, smaller quantities of the volume substitute were required in this group than in the group in which volume substitution was carried out with human albumin 5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Patients at intensive care units need very many drugs applicated via a central venous katheter. Particles caused by incompatibility reactions or coming from disposible materials possibly can provoke severe complications such as embolism, anaphylactoid reactions or ARDS. The combined use of multilumen katheters and Intrapur filters brings a significant reduction of these particles, as shown by an infusion regime.

Until now, recommendations for nutrition therapy of HIV-infected subjects can only be regarded as preliminary, because of the lack of scientific results regarding the interactions between HIV-infection and nutrition. HIV-infected patients have a high risk to become malnourished during the course of the disease, as a consequence of multiple pathogenetic factors--similar to the nutritional problems of tumor patients. At the moment, the following procedure is recommended in order to treat or prevent HIV-associated malnutrition: The nutritional status and history should be assessed in each HIV-positive subject as early as possible. Independent of the actual nutritional status, each patient should obtain a nutrition education. A continuous nutrition therapy becomes necessary in the case of evident or imminent malnutrition. Nutrients should be applied by oral access as long as possible. But especially for patients with opportunistic infections of the GI-tract accompanied by malabsorption, total parenteral nutrition may be the only effective way of nutrition.

There are three basic forms of the 170-year-old autologous blood transfusion. The intraoperative and perioperative autologous blood transfusion and the preoperative autologous blood donation and retransfusion. The latter is a preferred task of blood transfusion services. Indications and contraindications have to be carefully considered. Each step from the decision for autologous donation to the retransfusion has to be carried out with the same conscientiousness as any other preparation of blood units and performance of hemotherapy. Although the interest in autologous blood deposit has increased in the last 5 years the percentage of autologous blood donation is very small. In order to include all suitable patients in an autologous predeposit programme a close and understanding cooperation between hospitals and transfusion services is necessary. The frequency of autologous blood donations decreases if these requirements are not complied with.

We retrospectively studied 617 insertions of multilumen-catheters in 570 cardiosurgical patients. Number of catheters, insertion technique, indwelling period, catheter insertion site, specific positions and complications of insertion were evaluated by anesthetic chart and chest x-ray. In most cases the catheters were placed by a percutaneous insertion lock in the right or left v. jugularis interna as main site. Early complications mainly occurred because of incorrect placements. Post-operative radiological control by chest x-ray nearly showed 67% malpositions mainly resulting from the catheter placed not sufficiently far within the insertion lock. Though the catheter initially was placed correctly, it slided back to the insertion lock under mechanical influence on the site of fixation. In only 3 of 617 cases we found a too far inserted catheter. In these cases insertion was made by a Seldinger guidewire after direct venipuncture.

Obesity is associated with a number of changes in the endocrine system. Some of them occur as a result of the obesity, and some, such as changes in the secretion of adrenal steroids, may be causal. The importance of a reduction in the activity of the sympathetic nervous system in the control of obesity and nutrient regulation has been discussed. The influence of insulin and adrenal steroids on this system have been discussed in relation to changes in the activity of the sympathetic nervous system.

From the multicenter study of the Red Cross Blood Banks in the FRG HIV-antibody prevalences and incidences are documented since July 1985. Constantly low prevalences and incidences since 1987 of less than 2 Western blot (Wb)-positive donors and less than 1 Wb-positive donor per 100,000 donors respectively confirm our estimate of the rest risk of an HIV-infection by blood products of 1:500,000 to 1:3 million donations. In the epidemiologic details there seems to be a trend to an increase of the incidence in male repeat blood donors. The modes of HIV-infection in blood donors have changed to an increasing number of infections acquired in heterosexual contacts to persons at risk.

In order to ascertain the hemodynamic and biochemic effect of different colloid solutions, 60 patients scheduled for hip arthroplasty were randomly divided into two groups. Prior to surgery, acute normovolemic hemodilution was performed by withdrawal of 15 ml blood/kg bodyweight and simultaneous compensation using either 5% human albumine (HA) or 6% hydroxyethylstarch (200/0.5) (HAES), each group consisting of 30 patients. During and after the operation a decrease of hemoglobin-levels to 8 g% was accepted before autologous plus (if necessary) homologous blood was applied. Neither hemodilution nor tolerance of normovolemic anemia during the intra- and postoperative period had any negative effects on clinical course. Hemodynamics kept stable, no disorders of coagulation were observed. In addition lactate levels as well as histamin values remained within normal range during the whole investigation period (until the 10th postoperative day). There were no significant differences between the two groups; only histamine levels after albumin were up to 2.2 as high as after HAES. Colloid consumption at the day of operation was on the average 2.6 l/patient x day (HAES) and 3.11 (albumin) respectively. Colloidosmotic pressure remained constant in both groups and seemed to be independent from the kind of volume therapy. The present data demonstrate that normovolemic anemia can be tolerated during the perioperative period even when large amounts of colloid infusion are applied. HAES is an less expensive but adequate colloid solution compared to albumin.