血浆稀释因子:预测血浆和血清中的浓度如何受到血容量变化和失血的影响。

A Flordal
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引用次数: 0

摘要

为了确定治疗干预对血浆蛋白浓度的影响,通常需要排除血液稀释的非特异性影响。因为红细胞局限于血管空间,所以红细胞比容(Hct)是一个方便的标记。在床边,甚至在科学报告中,通常使用简单的hct比率(在血浆体积变化之前和之后获得)来“纠正”感兴趣的值。这是不正确的,它可能会带来相当大的错误。从数学上推导出了一种新的方法——血浆稀释因子(PDF)。它解释了任何失血、血浆渗透压变化和血容量变化对血浆和血清浓度的影响。在体外实验中,通过抽取不同体积的血液,用更小、相同或更大体积的低渗、等渗或高渗溶液代替,模拟失血、渗透压和血容量的变化。PDF准确预测白蛋白、纤维蛋白原和抗凝血酶III浓度的变化。相比之下,Hct比率明显低估了稀释的影响。志愿者通过右旋糖酐输注血液稀释后的血管性血友病因子浓度与PDF预测的相同。在接受骨科手术同时给予葡聚糖的患者中,稀释后的血管性血友病因子浓度高于PDF的预测。Hct给出了志愿者血液减少的错误印象,这不能用血液稀释来解释,它也不能检测出手术患者对创伤的血管性血友病因子反应。(摘要删节250字)
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The plasma dilution factor: predicting how concentrations in plasma and serum are affected by blood volume variations and blood loss.

To determine the effects of therapeutic interventions on plasma protein concentrations, it is often desirable to rule out nonspecific effects of hemodilution. Because red cells are restricted to the vascular space, the hematocrit (Hct) is a convenient marker. At the bedside--and even in scientific reports--a simple ratio of Hcts (obtained before and after the change in plasma volume) is often used to "correct" the value of interest. This is incorrect, and it may introduce a sizeable error. A new method, the plasma dilution factor (PDF), has been mathematically deduced. It accounts for the influence of any blood loss, plasma osmolality changes, and blood volume variations on plasma and serum concentrations. In an in vitro experiment, blood loss and osmolality and blood volume changes were simulated through the withdrawal of various volumes of blood, which were replaced with smaller, identical, or larger volumes of hypotonic, isotonic, or hypertonic solutions. The PDF accurately predicted changes in concentrations of albumin, fibrinogen, and antithrombin III. In contrast, the Hct ratio significantly underestimated the effects of dilution. Von Willebrand factor concentrations after hemodilution through dextran infusion in volunteers were the same as predicted by the PDF. In patients undergoing orthopedic surgery who were also given dextran, the postdilution von Willebrand factor concentrations were higher than predicted by the PDF. The Hct gave a false impression of a decrease in the volunteers that was not explained by hemodilution, and it failed to detect the von Willebrand factor response to trauma in the surgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)

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