Infusionstherapie (Basel, Switzerland)最新文献

The application of antibodies to tetanus toxin is necessary for prevention of postoperative tetanus in patients at risk, e.g. in emergency surgery. However, intravenous preparations with sufficiently rapid distribution throughout the body are not available. This could only be achieved via the blood products (whole blood unit, fresh frozen plasma, thrombocyte concentrate) transfused in such cases. For semiquantitative determination of antibody concentration in blood products, an ELISA assay was developed, which can be used as a screening method for selection of sera with high titers. The assay is quick and easy to perform so that large numbers of sera can be tested within a short time.

Thirty-two patients with segmental liver resection were fed 3 different parenteral infusion programs postoperatively. These differed in carbohydrate and lipid content, with the latter representing up to 40% of the total caloric content. Laboratory parameters, including nitrogen balance, acute phase proteins and liver function tests, were found to have a postoperative course similar to that seen following other major abdominal procedures. A transient rise of bilirubin observed may be related to the temporary decrease in the excretory function of the liver. The rise in acute phase proteins, beginning a few days postoperatively, was attributed to the ability of the remaining liver parenchyma to synthesize protein. There was no significant difference observed between the 3 parenteral solutions. Finally, we conclude that in the early postoperative period lipid solutions can be used as an important source of energy.

The aim of this study was to investigate the nitrogen-sparing effect of hypocaloric parenteral nutrition (HPN) with a balanced amino acid supply compared with that of a standard Rose's formula. Eighteen well-nourished patients with colorectal cancer were randomly distributed into 3 groups: I control, II Study group, III Rose's formula. The amount of non-protein calories was similar in both groups: 8 kcal/kg administered as glucose, and 1.33 g of amino acid/kg was also infused during 5 days. There were no differences in the plasma protein levels of total proteins, albumin, and transferrin, but retinol-binding protein was higher in group II compared with the control. Nitrogen balance was significantly better in group II than in group III during the 3rd and 4th days. There were differences in the concentration of aspartic acid and glycine in the plasmatic aminograms between groups II and III. It was concluded that the balanced amino acid solution does not significantly improve a patient's nutritional state. Nor have we observed that the balanced amino acid solution causes fewer modifications in the plasma aminograms. However, it does achieve a slight improvement in the nitrogen balances and the synthesis of retinol-binding protein.

The risks and adverse reactions of fresh frozen plasma (FFP) and coagulation components have changed considerably in the last few years because of the spread of HIV on the one hand, and the advances in preparation and sterilisation of the coagulation components on the other hand. Therefore, the indication for FFP and the various coagulation components deserves permanent consideration. FFP is still the therapeutical means of choice for the treatment of acquired (complex) plasmatic coagulation disorders, even though the (still) small risk of virus transmission in Middle Europe has to be taken into account. Coagulation components are primarily indicated in congenital (isolated) plasmatic coagulation disorders. Only in gross or very acute acquired coagulation disorders are coagulation components needed in addition to FFP. The same regimen is recommended for the use of antithrombin III (AT III) concentrates. In cases of acquired antithrombin deficiency, antithrombin III substitution is indicated only when the anticoagulation by heparin alone or in combination with FFP is insufficient or when the heparin dose required might cause an unacceptable bleeding risk, e.g. in simultaneous thrombocytopenia. Then AT III becomes an important therapeutic agent, especially in DIC. In addition, information regarding a rational and economic substitution of FFP and coagulation components is given, and other substitutes are mentioned which could possibly be used with less risk. Finally, the necessity of accurate diagnosing is emphasized. Close cooperation between the physicians in the clinics and in the department of transfusion medicine/hemostaseology reduces unnecessary and inadequate application of coagulation components. This also means an improvement in the patient's therapy.

The use of FFP has increased dramatically in the last few years. In the majority of cases FFP is transfused in order to provide coagulation factors. Many physicians expect to get "better" blood parameters from concomitant FFP and red blood cell (RBC) transfusions. To avoid the risk of diseases transmitted by homologous blood predeposited autologous blood is useful for elective surgical patients. Intraoperative autotransfusion by blood salvage using a Cell Saver only provides autologous RBC without plasma, so predeposited autologous plasma seems to be a necessary supplement. However, according to the literature most patients receiving RBC units do not require concomitant FFP. Guidelines for the use of FFP based on controlled clinical trials are necessary.

A total of 20 patients of both sexes received total parenteral nutrition with an all-in-one solution (excluding fat). All patients underwent a medium-sized surgical intervention. The solution was applied throughout 4 postoperative days in a medium dosage of 30 ml/kg B.w./day. Additional electrolyte solutions (200-500 ml/day) were allowed, to substitute fluid losses. Routine laboratory parameters remained in hemostasis; even blood sugar was stabilized between 120 and 150 mg% (x) without insulin. The authors conclude that short-term parenteral nutrition using this all-in-one solution exclusively could achieve hemostasis in clinically relevant parameters. No side effects were detected.